GIFT   OF 
MICHAEL  REESE 


BANDAGING 


DAVIS 


THE  PRINCIPLES  AND  PRACTICE 

OF 

BANDAGING 


BY 

GWILYM  G.  DAVIS,  M.  D. 

UNIVERSITIES    OF    PENNSYLVANIA    AND    GOTTINGBN;    MEMBER  OF  THE  ROYAL 

COLLEGE  OF  SURGEONS,   ENGLAND;  PROFESSOR  OF  ORTHOPEDIC 

SURGERY,   UNIVERSITY  OF  PENNSYLVANIA,   ETC. 


THIRD  EDITION,  REVISED 


ILLUSTRATED  FROM  ORIGINAL 
DRAWINGS    BY    THE    AUTHOR 


PHILADELPHIA 

P.   BiLAKISTON'S  SON  &  CO 

1012   WALNUT   STREET 


COPYRIGHTED  BY  GWILYM  G.  DAVIS,  1911. 


THE     MAPLE     PRESS     YORK    PA 


TO 

THE  MEMORY  OF  MY  TEACHERS 

PROF.  D.  HAYES  AGNEW,  M.  D.,  LL.   D. 

AS  A  TRIBUTE    TO   HIS   ABILITY  AS  A  SURGEON 

AND  OF  THE  LOVING  ESTEEM  IN  WHICH 

HE  WAS  HELD  BY  THE  MEMBERS 

OF  HIS  PROFESSION 

AND 

PROF.  JOHN  ASHHURST,  JR.,  A.  M.,  M.  D. 

WHOSE  WIDE  KNOWLEDGE  OF  THE  LITERATURE  OF  HIS 

PROFESSION  AND  WHOSE  EXACT  ATTENTION  TO 

THE   MINUTEST   DETAILS  OF  HIS  CASES 

ALWAYS  COMMANDED  MY  SINCERE 

ADMIRATION     AND     EVER 

STIMULATED  ME  TO 

EMULATE 

THIS  LITTLE  VOLUME  IS  DEDICATED 


376207 


PREFACE 

The  present  volume  is  based  on  a  previous  one  by  the 
same  author,  issued  in  1891.  The  illustrations,  however, 
have  all  been  redrawn  and  the  manuscript  rewritten,  so 
that  it  is  practically  a  new  book.  In  describing  the  roller 
bandages  an  endeavor  has  been  made  to  give  their  simplest 
and  best  mechanical  construction.  As  a  rule  only  the 
essential  turns  have  been  described  and  illustrated;  to 
have  done  more  would  be  simply  to  confuse  the  learner. 
Of  recent  years  the  prevalence  of  gauze  bandages  and 
their  substitution  for  those  of  muslin  have  caused  a  great 
deterioration  in  their  application.  Many  surgeons  seem 
to  wind  them  aimlessly  around  a  part  without  the  faintest 
idea  of  order  or  sequence. 

It  is  hardly  necessary  to  say  that  there  is  a  right  way 
and  a  wrong  way  to  apply  even  a  gauze  bandage,  and  the 
right  way  is  the  best  way.  No  attempt  has  been  made  to 
describe  all  peculiar  bandages  or  turns.  Every  surgeon 
will  modify  the  bandage  according  to  the  emergencies  of 
the  case,  but  the  bandages  and  turns  embodying  principles 
have  been  both  described  and  illustrated  in  detail.  Sim- 
plicity is  the  main  characteristic  of  the  modern  bandage. 
The  old  writers,  particularly  Galen,  describe  most  intri- 
cate bandages  winding  in  many  unusual  directions.  Al- 
most every  newly  invented  turn  can  be  found  in  the 
bandages  of  the  ancients.  Their  bandages  were  too  com- 
plex, while  we  on  the  other  hand  are  apt  to  be  ignorant  of 
their  proper  construction  and  careless  in  their  application. 

Inasmuch  as  the  book  is  intended  for  beginners  and 
others  not  informed  in  medicine,  the  language  used  has 
been  as  simple  and  direct  as  possible,  technical  terms  and 
expressions  being  avoided. 

1814  SPRUCE  STREET. 


CONTENTS 


PART   I.  THE  ROLLER  BANDAGES. 

PART  II.  THE  TAILED  BANDAGES  OR  SLINGS. 

PART  III.  THE  HANDKERCHIEF  BANDAGES. 


PART  I 

THE  ROLLER  BANDAGES 

PAGE 

THEIR  PREPARATION  AND  APPLICATION, i 

THE  FUNDAMENTAL  BANDAGES: 

1.  The  Circular  Bandage, 14 

2.  The  Spiral  Bandage  and  its  Modifications,    .......  14 

(a)  The  Slow  Spiral, 14 

Ascending, 14 

Descending, • 15 

(6)  The  Rapid  Spiral, 16 

(c)  The     Spiral     Principle     as     Applied    to     Spherical 

Parts, 16 

3.  The  Spiral  Reversed  Bandage, 17 

4.  The  Figure  8  Bandage, 20 

5.  The  Recurrent  Bandage, 20 

6.  The  Twisted  Bandage, 21 

7.  The  Knotted  Bandage, 21 

THE  SPECIAL  BANDAGES,  CLASSIFIED  ACCORDING  TO  REGIONS: 

1.  BANDAGES  or  THE  UPPER  EXTREMITY. 

2.  BANDAGES  OF  THE  LOWER  EXTREMITY. 

3.  BANDAGES  OF  THE  HEAD. 

4.  BANDAGES  OF  THE  TRUNK. 

i.  Bandages  of  the  Upper  Extremity: 

Spiral  of  the  Finger, 22 

Spiral  Reversed  of  the  Finger, 23 

Spica  of  the  Thumb, 24 

The  Demi-gauntlet, 25 


CONTENTS 

1.  Bandages  of  the  Upper  Extremity  (Continued):  PAGE 

The  Gauntlet, 26 

The  Spiral  Reversed  of  the  Upper  Extremity, 27 

The  Figure  8  of  the  Hand, 28 

Bandages  for  the  Elbow, 30 

The  Figure  8  of  the  Upper  Extremity, 31 

The  Spica  of  the  Shoulder ,. 32 

The  Figure  8  of  the  Shoulder  and  Axilla, 34 

2.  Bandages  of  the  Lower  Extremity: 

Spiral  Reversed  of  the  Lower  Extremity, 34 

Spiral  of  the  Heel 37 

Spica  of  the  Foot, 38 

Figure  8  of  the  Lower  Extremity, 39 

Bandages  for  the  Calf  of  the  Leg 39 

Bandages  for  the  Knee,      41 

Spica  of  the  Groin, 41 

Double  Spica  of  the  Groin, 43 

Crossed  Bandage  of  the  Perineum, 44 

3.  Bandages  of  the  Head: 

The  Monocle, 46 

TheBinocle, 48 

Transverse  Monocle, 49 

Oblique  of  the  Jaw, 49 

Double  Oblique  of  the  Jaw, 51 

Recurrent  of  the  Head, 52 

Capeline, 52 

Bandage  for  the  Front  of  the  Head, 53 

Transverse  Recurrent  of  the  Head, 54 

Bandage  for  the  Side  of  the  Head, 55 

Figure  8  of  the  Head  and  Jaw,     56 

Figure  8  of  the  head  and  Neck, 56 

Occipito-facial  Roller, 57 

Barton's  Bandage, 57 

Gibson's  Bandage, 58 

Transverse  Bandage  of  the  Scalp, 59 

Twisted  Bandage  of  the  Scalp, 61 

Knotted  Bandage  of  the  Temple, .  61 

Knotted  Bandage  of  the  Eyes,      62 

Knotted  Bandage  of  the  Lips, 62 

4.  Bandages  of  the  Trunk: 

Spiral  of  the  Chest, 62 


CONTENTS  XI 

4.  Bandages  of  the  Trunk  (Continued):  PAGE 

Figure  8  of  the  Chest, 63 

Anterior  Figure  8  of  the  Chest  and  Shoulders, 65 

Posterior  Figure  8  of  the  Chest  and  Shoulders, 66 

Suspensory  of  the  Breast, 67 

Suspensory  of  Both  Breasts,      68 

Kirvisch's  Method, 69 

Velpeau's  Bandage  for  Fractured  Clavicle, 69 

Desault's  Bandage, ." 71 

Gerdy's  Bandage, 74 

Bandage  to  Confine  the  Arm  to  the  Side, 75 

Bandage  for  Fracture  of  the  Elbow, 76 


PART  II 

THE  TAILED  BANDAGES  OR  SLINGS 

1.  TAILED  BANDAGES  or  THE  HEAD. 

2.  TAILED  BANDAGES  OF  THE  TRUNK. 

3.  TAILED  BANDAGES  OF  THE  EXTREMITIES ; 

1.  Tailed  Bandages  of  the  Head: 

The  Four-tailed  Bandage  of  the  Head,    ........  78 

The  Six-tailed  Bandage  of  Galen, 79 

Four-tailed  Sling  of  the  Chin, 79 

Four-tailed  Sling  of  the  Neck, 80 

Double  T  Bandage  of  the  Nose, 80 

The  T  Bandage  of  the  Ear,    . 81 

The  T  Bandage  of  the  Eye, 81 

2.  Tailed  Bandages  of  the  Trunk: 

Double  T  of  the  Chest, 82 

Double  T  of  the  Abdomen, 83 

The  Eight-tailed  Bandage  of  the  Abdomen, 83 

Double  T  Bandage  of  the  Perineum, 84 

T  Bandage  of  the  Groin,    . 85 

T  Bandage  of  the  Buttock, 86 

3.  Tailed  Bandages  of  the  Extremities: 

Four-tailed  Sling  of  the  Shoulder, 86 

Four-tailed  Sling  of  the  Axilla, 86 

Four-tailed  Sling  of  the  Arm, 86 

Perforated  T  Bandage  of  the  Hand, 87 

Four-tailed  Sling  of  the  Knee, 89 

Many-tailed  Bandage  of  Scultetus,      89 


Xll  CONTENTS 

PART  HI 

THE  HANDKERCHIEF  BANDAGES 

1.  HANDKERCHIEF  BANDAGES  FOR  THE  HEAD. 

2.  HANDKERCHIEF  BANDAGES  FOR  THE  HEAD  AND  TRUNK 

3.  HANDKERCHIEF  BANDAGES  FOR  THE  CHEST. 

4.  HANDKERCHIEF  BANDAGES  FOR  SLINGING  THE  ARM.  . 

5.  HANDKERCHIEF  BANDAGES  FOR  THE  UPPER  EXTREMITY. 

6.  HANDKERCHIEF  BANDAGES  FOR  THE  PUBIC  REGION. 

7.  HANDKERCHIEF  BANDAGES  FOR    THE   LOWER    EXTREMITY 

AND  TRUNK. 

8.  HANDKERCHIEF  BANDAGES  FOR  THE  LOWER  EXTREMITY. 

i.  Handkerchief  Bandages  for  the  Head:  PAGE 

Occipito-frontal  Triangle,  .    .    .    : 94 

Pronto-occipital  Triangle,      94 

Bi-temporal  Triangle, .  95 

Verti co-mental  Triangle, 95 

Auriculo-occipital  Triangle, 96 

Fronto-occipito-labialis  Cravat, 96 

Square  Cap  of  the  Head, 96 

The  Triangular  or  Hunter's  Cap  of  the  Head,   .    .  98 

2.  Handkerchiefs  for  the  Head  and  Trunk: 

Occipi to-sternal  Triangle, 99 

Parieto-axillary  Triangle, 99 

3.  Handkerchiefs  for  the  Chest: 

Dorso-bis-axillary  Triangle, 101 

Simple  Bis-axillary  Cravat, 101 

Compound  Bis-axillary  Cravat, 102 

Simple  Dorso-bis-axillary  Cravat, 102 

Compound  Dorso-bis-axillary  Cravat, 103 

Thoracico-dorsal  Triangle, 104 

Thoracico-lateral  Triangle, 106 

Triangular  Cap  of  the  Breast, 106 

4.  Handkerchiefs  for  Slinging  the  Arm: 

Brachio-cervical  Cravat, 106 

Simple  Brachio-cervical  Cravat, 106 

Compound  Brachio-cervical  Cravat, 106 

Simple  Brachio-cervical  Triangle, 108 


CONTENTS  X1U 

4.  Handkerchiefs  for  Slinging  the  Arm:  (Continued):  PAGE 

Compound  Brachio-cervical  Triangle, 108 

Oblique  Triangle  of  the  Arm  and  Chest,     ....  109 
Oblique  Triangle  of  the  Arm  and  Chest,  Second 

Method no 

Triangles  for   Suspension   of   the  Arm  from  the 

injured  Side, no 

First  Method, no 

Second  Method, in 

Third  Method, 112 

Fourth  Method, 112 

Mayor's  Bandage  for  Fractured  Clavicle,  .    .    .    .114 

Gosselin's  Bandage  for  Fractured  Clavicle,    ...  114 

5.  Handkerchiefs  for  the  Upper  Extremity: 

Triangular  Cap  of  the  Shoulder, 155 

Triangular  Cap  of  the  Shoulder,  Agnew's  Method,  116 

Palmar  Triangle 116 

Cravat  for  the  Hand, 117 

6.  Handkerchiefs  for  the  Pubic  Regions: 

Sarco-pubic  Triangle,      118 

Scrotal  Triangle,      118 

Scrotal  Square, 119 

7.  Handkerchiefs  for  the  Trunk  and  Lower  Extremity: 

Ilio-inguinal  Cravat, 120 

Double  Ilio-inguinal  Cravat, 120 

Ilio-femoral  Triangle,      122 

Tibio-cervical  Sling, 123 

Tarso-pelvic  Cravat, 123 

8.  Handkerchiefs  for  the  Lower  Extremity: 

Tarso-femoral  Cravat, 124 

Tarso-patellar  Cravat, 124 

Triangular  Cap  of  the  Knee, 124 

Tibial  Triangle, 125 

Tibial  Cravat, 125 

Tarso-malleolar  Cravat, 125 

Malleo-phalangeal  Triangle, 125 

Triangular  Cap  of  the  Heel, 126 

Triangular  Cap  for  Stumps, 126 

Barton's  Extension  Cravat, 127 

Gerdy's  Extension  Cravat, 128 


A  TREATISE  ON  BANDAGING 


PART  I 

THE  ROLLER  BANDAGES 

THEIR  PREPARATION  AND  APPLICATION 

The  roller  bandage  is  a  strip  of  muslin  or  other  fabric, 
varying  in  length  and  width,  wound  on  itself,  forming  a 
compact  roll  (Fig.  i). 


FIG.  i. — ROLLER  BANDAGE. 


The  Double  Roller. — When  each  extremity  is  wound  to- 
ward the  middle,  forming  two  cylinders,  it  is  called  a  double 
roller  or  double-headed  bandage  (Fig.  2). 


6ANDAGING 


A  roller  bandage  is  spoken  of  as  having  an  upper  and  a 
lower  edge,  an  inner  and  an  outer  surface,  a  body  and 
two  extremities,  one  being  the  initial  extremity  or  begin- 
ning, and  the  other  the  terminal  extremity  or  end. 

The  Material  of  which  bandages  are  made  depends  on 
the  uses  for  which  they  are  intended.  It  may  be  of  mus- 
lin, flannel,  gauze,  or  cheese-cloth,  crinoline  and  plaster, 
or  rubber. 

Rubber. — If  it  is  desired  to  render  a  limb  bloodless  by 
Esmarch's  method,  a  rubber  bandage  is  used.  It  is  also 

employed  in  the  treat- 
ment of  leg  ulcers, 
swellings,  affections  of 
the  joints,  etc. 

Gauze  or  Cheesecloth. 
—Bandages  made  of 
gauze,  such  as  is  used 
for  surgical  dressings, 

FIG.  2 — DOUBLE  ROLLER  BANDAGE. 

have  almost  wholly 

displaced  those  made  of  muslin.  In  applying  them 
reverses  should  seldom  be  employed.  They  adapt  them- 
selves more  neatly  to  the  part  and  are  less  liable  to  dis- 
placement than  the  muslin  bandages. 

Plaster  bandages  are  those  made  of  crinoline  or  gauze, 
into  the  meshes  of  which  plaster-of-Paris  has  been 
rubbed. 

Flannel. — Flannel  bandages  are  used  in  certain  impor- 
tant operations  where  expense  is  a  secondary  considera- 
tion and  it  is  desirable  to  have  a  more  elastic  bandage 
than  one  made  of  muslin.  They  adapt  themselves  more 
readily  to  uneven  surfaces,  make  a  more  equable  com- 
pression, and  are  less  liable  to  displacement.  The  great- 
est objection  to  them  is  their  expense.  They  are  most 
often  used  in  bandaging  the  eyes  and  in  covering  a  part 
previous  to  the  application  of  a  plaster  dressing. 

Muslin. — Bandages    made    of    unbleached    muslin    are 


ROLLING    OF  BANDAGES   BY    MACHINE  3 

still    sometimes    used,    especially    for    dressing    fractures, 
retaining  applications  to  a  part,  etc. 

PREPARATION  OF  BANDAGES 

Gauze  Bandages. — These  are  made  by  tightly  rolling  a 
strip  of  gauze,  eight  or  ten  yards  long,  embracing  its 
entire  width,  into  a  long  compact  cylinder.  This  is  then 
cut  across  with  a  large  knife  into  bandages  of  the  width 
desired. 

Muslin  Bandages. — A  piece  of  unbleached  muslin  of 
medium  quality,  corresponding  to  the  length  of  the  band- 
age desired,  is  taken  and,  after  the  selvedge  has  been  torn 
off,  one  extremity  is  divided  into  as  many  ends  as  it  is 
desired  to  have  bandages.  Each  strip  is  then  torn  down 
for  about  two  feet.  We  now  have  one  end  of  the  piece 
torn  into  strips,  each  about  two  feet  long.  The  alternate 
strips  are  then  separated,  half  on  one  side  and  half  on  the 
other.  Those  on  one  side  are  gathered  together  and  held 
firmly  by  one  person,  and  those  on  the  other  by  an  assist- 
ant. Each  now  pulls  strongly  until  the  piece  of  muslin 
is  torn  through  its  entire  length,  making  eighteen  strips, 
each  the  entire  length  of  the  piece.  A  few  of  the  ravelings 
are  now  picked  off,  to  prevent  tangling,  and  the  strips 
laid  lengthwise  and  straightened  out.  They  are  now  ready 
for  rolling. 

ROLLING  OF  BANDAGES 

By  Machine. — To  roll  these  strips  into  cylinders,  if  many 
are  to  be  prepared,  a  machine  called  a  bandage  roller  is 
used  (Fig.  3).  It  consists  of  a  small  winch  held  in  place  by 
two  uprights  and  fastened  to  a  table.  The  axis  is  not 
round,  but  square  or  hexagonal,  and  tapering,  being  thicker 
at  the  end  near  the  handle.  Two  or  more  round  pegs 
bind  the  sides  together  and  serve  to  flatten  out  the  band- 


BANDAGING 


age  as  it  is  wound  on  the  axis.  After  being  moistened  with 
water  from  a  sponge  the  end  of  one  of  the  strips  is  passed 
between  or  around  the  pegs  and  wound  around  the  thin 
end  of  the  axis.  It  is  then  pushed  toward  the  thick  end, 
until  it  is  perfectly  tight.  The  bandage  is  now  guided  by 
the  left  hand  while  the  handle  is  turned  with  the  right. 
The  handle  should  be  kept  firmly  pressed  against  the  up- 
right and  not  allowed 
to  slide  in  and  out, 
as  that  will  make  the 
bandage  uneven. 
Some  think  they  can 
wind  the  bandage 
more  evenly  if  one 
edge  is  kept  close  up 
to  the  side  of  the 
machine. 

When  the  bandage 
is  nearly  all  wound, 
the  roll5is  grasped 
with  one  hand  and 
held  while  two  or 
three  additional  turns 

are  given;  this  makes  it  more  firm  and  solid.  To  loosen 
the  roller,  grasp  it  firmly  with  one  hand  and  reverse  the 
crank  two  or  three  times  and  draw  it  out  completely. 

The  ravelings  have  been  pulled  off,  the  end  of  the 
bandage  is  to  be  turned  under  and  pinned. 

If  it  is  desired  to  place  the  pin  lengthwise  in  the  roller, 
then  the  whole  end  should  be  folded  under;  but  if  cross- 
wise, then  each  corner  should  be  turned  under  and  the  pin 
put  in  the  apex  so  formed,  care  being  taken  that  the  point 
of  the  pin  does  not  project. 

Another  way  to  fasten  the  end  is  to  put  a  small  strip 
of  adhesive  plaster  about  an  inch  long  on  it;  still  another 
is  to  moisten  the  end  for  two  or  three  inches  with  water 


FIG.  3. 


ROLLING   OF  BANDAGES  BY  HAND  5 

and  then  finish  winding  it.  There  is  enough  sizing  in  un- 
bleached muslin  to  make  the  end  adhere  without  pinning. 

When  large  numbers  of  bandages  are  to  be  rolled,  as 
in  hospitals,  it  is  well  to  allow  some  of  the  patients  to  roll 
them  up  loosely  and  then  have  them  re-rolled  by  an  ex- 
perienced hand. 

Bandages  intended  for  ambulance  or  other  outside  use 
should  be  secured  with  a  pin,  to  be  used  in  fastening  it 
after  its  application. 


PIG.  4. — ROLLING  BY  HAND. 


PIG.  5. — GRASPING  THE  ROLL. 


By  Hand. — A  properly  prepared  bandage  should  be 
even  on  the  edges  and  tightly  rolled.  It  is  difficult  to  apply 
satisfactorily  a  loosely  rolled  bandage.  With  a  machine 
they  can  be  rolled  better  and  more  quickly  than  by  hand, 
yet  it  behooves  all  who  use  bandages  to  be  able  to  roll 
them  skilfully  without  it,  as  it  will  often  be  necessary  for 
them  to  do  so.  To  roll  a  bandage  by  hand  proceed  as 
follows:  Two  feet  of  the  end  of  the  bandage  is  folded  re- 
peatedly on  itself  until  a  firm,  compact  mass  is  made. 
This  is  rolled  first  with  the  fingers  and  then  on  the  thigh, 


6  BANDAGING 

the  loose  bandage  being  kept  taut  by  the  other  hand, 
until  a  roll  is  formed  sufficiently  large  to  roll  with  both 
hands  and  not  to  bend  when  held  between  the  finger  and 
thumb,  as  seen  in  figure  4. 

Grasp  the  roll  between  the  thumb  and  index  or  first  two 
fingers  of  the  right  hand,  the  body  of  the  roller  being  under- 
neath (Fig.  4).  Then  place  it  in  the  left  hand,  the  lower 


FIG.  6. — ROLLING  BY  HAND.     WINDING  THE  ROLL. 

edge  of  the  loose  bandage  touching  the  web  of  the  thunib 
and  index  finger  (Fig.  5).  The  roll  is  now  held  by  the 
thumb  and  finger  of  the  right  hand  while  the  remaining  part 
of  the  bandage  lies  between  the  thumb  and  extended  index 
and  middle  fingers  of  the  left  (Fig.  6).  The  bandage  is 
rolled  by  pronating  and  supinating  both  hands  at  the 
same  time,  the  hold  on  the  roll  by  the  right  hand  being 
released  during  each  movement  of  pronation.  The  band- 


PREPARING    OF   PLASTER  BANDAGES  7 

age  is  guided  and  made  tense  by  pressure  of  the  thumb 
and  forefinger  of  the  left  hand  as  it  passes  between  them. 
Considerable  practice  is  required  to  roll  bandages  well. 


PREPARING  PLASTER  BANDAGES 

The  gauze  used  in  making  plaster  bandages  is  stiffened 
with  starch  sizing  and  is  called  crinoline  or  mosquito  net- 
ting. It  should  have  a  mesh  about  thirty  or  forty  to  the 
inch. 

Gauze  sized  with  dextrin  is  unsuitable.  To  be  sure  that 
starch  sizing  has  been  acid  touch  it  with  a  solution  of 


FIG.  7. 


iodine  and  a  blue  color  results.  Dr.  Meisenbach  recom- 
mends that  known  to  the  trade  as  the  Vigilant  Brand. 
It  can  be  torn  into  strips  of  the  required  size,  as  is  done 
with  muslin.  Six  yards  will  be  found  to  be  long  enough. 
I  prefer  them  four  inches  broad.  If  only  a  small  number 
are  required  they  can  readily  be  prepared  by  spreading 
the  plaster  on  the  bandage  with  one  hand  or  the  back  of 
a  table  knife  while  the  other  rolls  it  up  loosely.  When 
large  numbers  are  required,  they  may  be  prepared  with 
a  machine  (Fig.  7). 

A  trough  is  made  composed  of  a  bottom  and  two  sides. 
It  should  be  about  fourteen  inches  long,  four  inches  high, 
and  six  inches  wide.  At  one  end  an  incline  is  inserted 
beginning  on  the  bottom,  four  inches  from  the  end,  and 
going  up  to  the  corner.  At  the  bottom  of  this  incline  a 


8  BANDAGING 

round  peg  goes  across  from  side  to  side  about  a  half-inch 
distant  from  the  incline  and  the  bottom  of  the  box.  Near 
the  middle  of  the  box  an  upright  board  is  placed  in  grooves. 

A  winch  is  put  in  the  remaining  end  of  the  box  and  a 
zinc  tray  placed  beneath  to  catch  any  falling  plaster. 

The  bandage  is  to  be  drawn  over  the  edge  of  the  incline, 
pushed  beneath  the  round  peg  with  a  spatula,  then  be- 
neath the  upright  board,  and  fastened  to  the  winch.  The 
box,  from  the  upright  board  to  the  incline,  is  then  filled  to 
the  top  with  plaster-of-Paris  in  powder  and  the  bandage 
wound  around  the  winch. 

It  is  preferable  to  pass  the  bandage  through  and  fasten 
it  on  the  winch  while  the  box  is  empty,  the  plaster  being 
put  in  afterward.  When  a  bandage  is  nearly  done,  its 
end  may  be  pinned  to  the  upper  (not  under)  surface  of  a 
new  bandage  and  drawn  through.  The  two  ends  are 
then  unpinned  and  the  completed  bandage  removed  from 
the  winch.  From  time  to  time  the  tray  beneath  the  winch 
may  be  removed  and  any  plaster  it  contains  dumped  into 
the  other  end  of  the  box. 

In  using  plaster  bandages  they  should  be  placed  on 
their  side  in  a  cup  of  warm  water — about  70°.  The  water 
should  cover  the  bandage  completely,  and  the  latter  should 
be  allowed  to  remain  immersed  until  the  air  bubbles  cease 
coming  to  the  surface.  On  removal,  the  bandage  should  be 
grasped  with  a  hand  at  each  end  and  squeezed  gently  to 
remove  the  surplus  water.  A  solution  of  gelatin  added  to 
the  water  delays  setting,  and  a  small  amount  of  salt  hastens 
it.  The  former  strengthens  the  bandage  and  the  latter 
weakens ,  it.  As  a  rule  neither  should  be  used.  Five  per 
cent  of  Portland  Cement  greatly  increases  the  strength. 

APPLICATION  OF  THE  ROLLER  BANDAGE 

In  applying  a  bandage  perfection  should  be  aimed  at. 
Slipshod,  carelessly  applied  bandages  should  not  be  toler- 


APPLICATION   OF   THE   ROLLER  BANDAGE  Q 

ated,  albeit  they  are  common  enough.  It  should  never 
be  forgotten  that  a  well-applied  bandage  is  one  that  ac- 
complishes the  object  with  the  expenditure  of  the  least 
amount  of  material  and  that  has  the  least  liability  to  dis- 
placement. Useless  turns  should  be  avoided.  They  only 
consume  additional  bandage,  heat  the  part  more,  and 
will  not  atone  for  the  faulty  application  of  the  previous 
part  of  the  bandage. 

A  bandage  should  be  applied  firmly  and  evenly,  but 
not  tightly,  nor  yet  too  loosely.  If  too  tight  it  will  cause 
pain,  inflammation,  and  sloughing;  if  too  loose  it  will 
soon  become  displaced. 

Security. — Security  is  obtained  by  a  careful  applica- 
tion in  the  first  place  and  not  by  promiscuous  turns,  wander- 
ing in  all  directions,  laid  on  after  the  bandage  proper  is 
completed.  If  still  greater  security  is  desired  than  can  be 
obtained  by  proper  application  and  pinning,  it  can  be 
had  by  the  use  of  strips  of  adhesive  plaster  laid  on  across 
the  turns,  or  by  tacking  the  turns  together  with  needle 
and  thread.  Bandaging,  although  more  of  an  art  than 
a  science,  is  nevertheless  governed  by  certain  fundamental 
principles,  the  ignoring  of  which  is  followed  by  bad  results. 
A  certain  amount  of  skill  and  dexterity  is  also  requisite. 
Therefore  practice  is  necessary,  and  proficiency  is  only 
acquired  after  repeated  trials. 

It  is  not  necessary  to  devise  special  turns  for  every 
case  that  presents  itself.  The  standard  bandages,  which 
have  stood  the  test  of  time,  were  devised  for  just  such 
cases  as  will  be  met  with  in  actual  practice,  and  a  de- 
parture from  them  will  almost  be  a  step  in  the  wrong 
direction. 

Gaping. — A  bandage  is  said  to  lie  flat  when  its  under 
surface  is  in  contact  with  the  part  to  which  it  is  applied. 
When,  however,  the  direction  of  the  bandage  is  such  that 
only  one  of  its  edges  comes  in  contact  with  the  part,  allow- 
ing a  space  to  exist  between  the  other  edge  and  the  surface 


10 


BANDAGING 


beneath,  then  the  bandage  is  said  to  gape,  and  forms  what 
is  known  in  French  as  the  godet. 

When  a  bandage  is  completed,  it  should  show  little  or  no 
gaping  of  the  turns,  otherwise  it  is  apt  to  be  both  ineffi- 
cient and  insecure.  If  the  bandage  were  inelastic  and  the 
parts  immobile,  then  gapes  would  be  frequent;  but  the 
elasticity  of  the  bandage  and  mobility  of  the  parts  aid 
much  in  avoiding  them. 

Dropping  a  Bandage. — To  drop  a  bandage  while  apply- 
ing it  is  an  unpardonable  sin.  If,  however,  the  body  of 


FIG.  8. — REMOVING  A  BANDAGE. 


the  bandage  falls  while  the  initial  extremity  is  held  by 
the  opposite  hand,  it  also  should  be  released  at  once,  so 
that  the  entire  bandage  drops  together.  By  so  doing 
the  roll  is  not  so  liable  to  unwind  itself  as  it  otherwise 
would  be. 

Removing  a  Bandage. — In  removing  a  bandage  from 
a  part,  the  turns,  as  they  are  unwound,  should  be  gathered 


.     APPLICATION    OF    THE    ROLLER  BANDAGE  II 

together  and  passed  en  masse  from  one  hand  to  the  other. 
(See  Fig.  8.) 

Pinning. — In  pinning  a  bandage  the  pins  should  have 
the  points  down  and  well  concealed  in  the  folds  of  the 
bandage;  if  they  are  put  in  longitudinally  the  heads  should 
be  toward  the  terminal  extremity  of  the  bandage. 

A  pin  should  not  be  so  placed  that  a  prominence  of  the 
part  beneath  will  make  its  point  project.  If  this  is  liable 


FIG.  9. — APPLYING  A  BANDAGE — METHOD  OF  HOLDING. 

to  occur,  shorten  the  bandage  by  doubling  its  end  under 
and  then  pin  it. 

Commencing  a  Bandage. — In  commencing  a  bandage 
the  roller  should  be  unwound  for  a  few  inches  and  grasped 
in  the  hand,  the  thumb  being  up  and  the  fingers  under- 
neath, the  loose  portion  of  the  bandage  coming  off  from 
its  under  surface  as  shown  in  figure  9. 

The  external  surface  of  the  initial  extremity  should 
then  be  placed  on  the  part  where  it  is  proposed  to  commence 
and  from  one  to  two  complete  turns  made,  and  then  the 
bandage  proceeded  with. 

The  tendency  of  a  bandage  to  become  loose  by  sliding 
from  the  thicker  to  the  thinner  end  of  the  part  makes  it 
necessary  to  begin  it  at  the  point  of  least  diameter.  Thus, 
the  wrist  and  ankle  are  the  proper  places  to  commence 
bandages  of  the  extremities,  and  when  a  bandage  is  to  in- 


12 


BANDAGING 


volve  both  an  extremity  and  the  trunk,  it  is  usually  consid- 
ered preferable  to  begin  it  on  the  extremity. 

If  a  simple  circular  bandage  is  to  be  placed  on  a  cylin- 
dric  part,  the  initial  extremity  should  be  placed  at  right 
angles  to  its  long  axis,  the  turns  going  transversely  around 
it  (Fig.  10).  If,  however,  it  is  desired  to  simply  fix  a 
bandage  and  then  proceed  to  bandage  either  above  or 


FIG.  10. — FIXING  BY  A  CIRCULAR 
TURN. 


FIG.  n. — FIXING  BY  AN  OBLIQUE 
TURN. 


below  the  point  of  fixation,  as  in  covering  the  extremities, 
then  the  initial  extremity  should  be  placed  where  the 
parts  are  conic  instead  of  cylindric,  and  it  should  be  laid 
on  obliquely. 

Thus,  in  commencing  a  bandage  of  the  foot,  by  fixing 
it  around  the  ankle,  the  bandage  should  be  placed  ob- 
liquely in  front  of  the  joint  (Fig.  u).  Here  the  swell  of 
the  ankle  makes  a  short  cone  with  the  base  down,  and 
by  putting  the  initial  extremity  obliquely  on  the  part,  at 
the  completion  of  the  turn  it  can  be  continued  downward 


THE  FUNDAMENTAL  BANDAGES  13 

without  the  formation  of  any  gapes.  If  greater  security 
is  desired,  two  turns  instead  of  one  may  be  made  around 
the  part. 

Ending  a  Bandage. — When  the  bandage  proper  has 
been  completed,  it  may  either  be  fastened  and  the  sur- 
plus cut  off,  or  else  a  few  additional  turns  made  until  it 
is  exhausted.  If  the  terminal  extremity  comes  over  the 
injured  part,  the  bandage  should  be  shortened  by  turning 
its  end  under,  thus  removing  it  to  a  less  sensitive  place. 
It  is  also  better  not  to  end  it  on  a  bony  prominence,  as 
that  will  tend  to  make  the  point  of  the  pin  project.  When 
it  is  not  desired  to  pin  the  terminal  extremity,  it  may  be 
fastened  by  splitting  it  and  tying  the  two  ends  around 
the  part.  This  is  often  done  with  the  finger  bandages. 

THE  FUNDAMENTAL  BANDAGES 

In  analyzing  the  various  special  bandages  as  they  are 
employed  in  surgery,  we  find  that  they  are  composed  of 
a  number  of  simple  or  elementary  turns,  which  we  may 
call  the  fundamental  bandages.  Each  part  of  every  spe- 
cial bandage  is  composed  of  one  or  more  of  these  elemen- 
tary turns  or  bandages,  multiplied  or  arranged  according 
to  the  part  to  which  they  are  to  be  applied  and  the  indica- 
tions they  are  intended  to  fulfil. 

These  fundamental  bandages,  together  with  the  methods 
of  their  construction  and  application,  constitute  the  founda- 
tion on  which  all  general  bandaging  is  based. 

A  thorough  knowledge  of  these  principles  should  be 
acquired  before  taking  up  any  of  the  special  bandages.  A 
surgeon  may  be  pardoned  for  not  remembering  the  peculiar 
turns  of  some  of  the  many  special  bandages.,  but  not  for 
showing  his  ignorance  of  the  great  principles  on  which 
good  surgery  depends. 

The  fundamental  bandages  may  be  classified  according 


14  BANDAGING 

to  their  construction,  as  follows:  the  circular,  the  spiral, 
spiral  reversed,  figure  eight,  recurrent,  twisted,  and  knotted. 

THE  CIRCULAR  BANDAGE 

The  circular  bandage  is  applicable  to  cylindric  parts. 
While  there  are  few  parts  of  the  body  that  are  perfect 
cylinders,  still,  owing  to  the  elasticity  of  the  bandage 
and  the  softness  of  the  structures, 
where  the  departure  is  not  marked, 
they  may  be  considered  and  treated 
as  cylinders;  thus,  an  uneven  or 
slightly  conical  part  may  be  bandaged 
as  though  it  were  cylindric. 

The  circular  bandage  consists  of 
two  or  three  turns  transversely  around 
a  part,  the  initial  extremity  being 
placed  at  right  angles  to  its  long  axis, 
and  each  turn  covering  exactly  the 

FIG.   12. — CIRCULAR  ...  T,    .       ,  ~ 

BANDAGE.  preceding  one.     It  is  shown  in  figure 

12.     It  is  applicable  to  almost  every 

portion  of  the  extremities  and  trunk.  When  a  circular 
turn  has  been  placed  around  one  side  of  the  neck  and 
opposite  armpit,  it  has  been  called  by  some  authors  an 
oblique  bandage;  but  it  is  obvious  that  it  does  not  differ 
in  principle  from  a  circular  bandage  of  the  neck  or  any 
other  portion  of  the  body. 

THE  SPIRAL  BANDAGE 

A  spiral  bandage  is  one  which  covers  a  part  by  turns 
which  encircle  it  in  a  spiral  manner,  like  a  corkscrew. 
The  spiral  bandage  may  be  either  a  slow  spiral  or  a  rapid 
spiral.  It  may  be  ascending  or  descending,  and  is  also 
applicable  to  spherical  parts. 

The  Slow  Ascending  Spiral. — A  slow  spiral  is  applicable 


THE    SPIRAL  BANDAGE  15 

to  a  cylindric  part  or  to  a  cone  the  size  of  which  increases 
but  slowly.  It  is  applied  as  follows:  Beginning  with  a 
circular  turn,  the  bandage  is  inclined  slightly  upward  and 
wound  spirally  around  the  part,  each  turn  overlapping 
the  preceding  one-half  to  two-thirds  of  its  width.  If  so 


FIG.  13. — SLOW  ASCENDING  SPIRAL  BANDAGE. 

desired  it  may  be  finished  by  a  circular  turn.  The  three 
turns  covering  the  wrist,  in  figure  13,  are  slow  ascending 
spiral  turns. 

Descending  Slow  Spiral. — Sometimes  it  is  desirable  to 
cover  a  part  from  above  downward  by  slow  spiral  turns. 


FIG.  14. — DESCENDING  SLOW  SPIRAL. 


When  this  is  done  it  forms  the  descending  slow  spiral.  If 
the  part  is  cylindric  the  turns  will  lie  flat  on  its  surface 
and  an  overlapping  of  half  the  width  of  the  bandage  will 
be  sufficient;  but  if  it  is  slightly  conical,  the  upper  part 
of  the  bandage  will  touch  while  the  lower  part  will  gape. 
The  amount  of  gaping  will  depend  on  the  rapidity  of  de- 
crease in  the  size  of  the  part.  (See  Fig.  14.)  On  account 


i6 


BANDAGING 


of  this  gaping  the  overlapping  should  be  about  two-thirds 
of  the  width  of  the  bandage.  When  the  bandage,  thus 
applied,  is  finished,  it  presents  a  smooth  appearance  and 
shows  no  gaping. 

The  descending  slow  spiral  is  employed  in  the  spiral 
bandage  of  the  chest;  in  going  from  the  point  of  greatest 


FIG.  15. — RAPID  SPIRAL. 

diameter  of  the  calf  of  the  leg  to  the  knee;  in  bandaging 
some  portions  of  the  upper  extremity,  and  in  the  applica- 
tion of  splints. 

The  Rapid  Spiral. — A  rapid  spiral  or  oblique  bandage 
is  one  which  ascends  a  part  in  rapid  spiral  turns,  leaving 
an  interspace  between  them.  It  is  employed  to  confine, 

loosely,  dressings  to  the  ex- 
tremities, as  in  cases  of  burns, 
or  as  a  bandage  for  temporary 
use.  (See  Fig.  15.) 

The  Spiral  Principle  as 
Applied  to  Spherical  Parts.— 
The  spiral  principle  can  also 
be  employed  in  bandaging 
spherical  parts,  such  as  the 
skull.  Here  it  should  always 
be  borne  in  mind  that  the 
most  secure  turn  is  a  diameter 

of  the  part.  Therefore,  whenever  it  is  possible,  parallel 
turns  should  be  avoided.  The  farther  away  they  get  from 
the  diameter,  the  more  insecure  they  become.  The  turns, 
being  all  diameters  (more  correctly,  great  circles)  of  the 


FIG.  16. — SPHERE    BANDAGED    BY 
SPIRAL  TURNS. 


THE   SPIRAL   REVERSED  BANDAGE  17 

sphere,  radiate  from  a  common  center  corresponding  to 
its  axis,  and  therefore  make  a  double  fan-like  arrange- 
ment. This  is  shown  in  figure  16.  The  first  turn,  i-i, 
goes  directly  around  the  sphere.  The  second  turn,  2-2, 
goes  higher  up  on  the  right  and  lower  down  on  the  left. 
Each  succeeding  turn  overlaps  the  preceding  one-half 
its  width.  The  bandage  can  be  continued  in  the  same 
manner  until  the  whole  sphere  is  covered.  It  will  be  seen 
that  these  turns  are  analogous  to  those  of  the  slow  spiral, 
except  that,  being  applied  to  a  spherical  instead  of  a  cylin- 
dric  part,  they  progress  around  instead  of  ascending  it. 


FIG.  17. — THE  SPIRAL  REVERSE.     PREPARING  TO  REVERSE. 

This  principle  is  applicable  to  bandages  of  the  head,  but 
is  also  useful  in  bandages  to  retain  surgical  dressings  after 
operations,  etc. 


THE  SPIRAL  REVERSED  BANDAGE 

In  order  to  completely  cover  a  part  which  has  the  shape 
of  a  rapidly  increasing  cone  and  still  have  the  bandage  lie 
flat,  it  is  necessary  to  change  the  direction  of  the  spiral 
turns  frequently  by  what  is  known  as  a  reverse.  Hence 


1 8  BANDAGING 

the  bandage  is  known  as  the  spiral  reversed.  A  reverse 
is  necessary  whenever  it  is  desired  to  change  abruptly  the 
course  of  a  bandage.  This  occurs  in  bandaging  a  conical 
part  when  the  size  increases  so  rapidly  as  to  cause  the  turns 
of  the  spiral  to  become  separated. 

The  reverse  is  made  as  follows:  Fix  the  initial  extremity 
and  carry  the  bandage  obliquely  upward  across  the  limb. 
The  body  of  the  bandage  being  held  by  the  thumb  and 
ringers  of  the  right  hand,  and  having  not  more  than  five 
inches  of  it  unrolled,  it  is  so  inclined  upward  as  to  cause 


FIG.  1 8. — THE  SPIRAL  REVERSE.     THE  ROLLER  REVERSED. 

its  outer  surface  to  lie  flat  on  the  part  beneath;  traction 
being  made,  the  thumb  of  the  left  hand  (the  fingers  being 
on  the  under  side  of  the  limb)  is  pressed  on  the  bandage 
to  prevent  its  loosening  on  making  the  reverse.  This 
position  is  shown  in  figure  17. 

The  roller  is  then  approached  to  the  limb,  thus  loosen- 
ing the  bandage,  and  the  right  hand  pronated,  the  bandage 
being  turned  over  or  reversed,  and  carried  at  first  directly 
down  the  limb,  and  then  obliquely  to  the  right  until  its 
lower  edge  is  parallel  to  the  lower  edge  of  the  preceding 


THE    SPIRAL   REVERSED  BANDAGE  1 9 

turn.  (See  Fig.  18.)  The  reverse  is  to  be  settled  by  a 
couple  of  gentle  pulls  and  the  body  of  the  roller  passed 
around  the  limb  and  grasped  by  the  fingers  of  the  left  hand. 
The  thumb  being  removed,  the  bandage  is  drawn  as  firmly 
as  desired  and  brought  up  and  passed  into  the  right  hand 
and  the  reverse  repeated. 

They  should  be  continued  as  long  as  the  limb  increases 
in  size,  but  when  it  is  stationary  or  a  decrease  occurs,  then 
the  part  can  be  covered  by  a  slow  spiral  and  no  reverses 
should  be  made.  Thus,  the  reverses  should  cease  in  the 


FIG.  19. — FIGURE  8  BANDAGE. 

leg  when  the  point  of  greatest  circumference  of  the  calf 
is  reached,  and  in  the  forearm  before  the  elbow  is  reached . 
In  bandaging  a  conical  part  the  reverse  is  always  made 
toward  the  small  end  or  point  of  the  cone.  The  conical 
parts  of  the  extremities  on  which  reverses  are  necessary  are 
all  pointed  downward,  so  that  the  reverse  is  made  toward 
the  operator  and  while  the  bandage  is  proceeding  from  the 
point  toward  the  base  of  the  cone.  A  reverse  made  away 
from  the  operator  and  while  the  bandage  is  proceeding 
from  the  base  toward  the  point  of  the  cone  is  never  allow- 
able. It  is  taught  by  many,  particularly  the  French,  but 
the  only  descending  cones  we  have  in  the  body  can  be 
better  bandaged  by  slow  spiral  turns. 


20 


BANDAGING 


In  applying  gauze  and  plaster-of-Paris  bandages  reverses 
should  be  avoided;  figure  8  turns  are  preferable. 

THE  FIGURE  8  BANDAGE 

The  figure  8  principle  is  the  one  most  used  of  any  in  band- 
aging. It  consists  of  two  loops  of  bandage  made  in  the  form 
of  a  figure  8.  (See  Fig.  19.)  When  a  number  of  figure  8 


FIG.     20. — SPICA  BANDAGE. 


FIG.  21. — RECURRENT"^  AND  AGE. 


turns  are  made,  each  a  little  higher  than  the  preceding  one, 
they  form  what  is  called,  from  its  imbricated  appearance  or 
resemblance  to  a  spike  of  barley,  a  spica  bandage.  (See 
Fig.  20.) 

THE  RECURRENT  BANDAGE 

When  it  is  desired  to  retain  a  dressing  on  the  face  of  a 
stump,  or  on  the  top  of  the  head,  or  to  cover  the  end  of  a 
finger,  then  a  bandage  called  the  recurrent  is  used.  It  is 
applied  as  follows:  After  first  fixing  the  initial  extremity 


THE   KNOTTED  BANDAGE  21 

around  the  part,  a  reverse  is  made  and  the  roller  passed 
backward  and  forward  over  the  end  of  the  part  until  it  is 
completely  covered,  and  then  finished  by  a  few  circular 
turns.  The  first  recurrent  turn  goes  directly  across  the 
middle  of  the  part  and  each  alternate  turn  is  made  on 
either  side  of  it.  (See  Fig.  21.) 

Owing  to  the  fact  that  the  recurrent  turns  are  not  firmly 
attached,  this  bandage  is  very  liable*to  displacement  and  is 
not  to  be  used  except  in  cases  of  absolute  necessity. 

THE  TWISTED  BANDAGE 

When  it  is  desired  to  secure  a  turn  over  a  projecting  bony 
prominence  or  small  dressing,  it  can  be  done  by  sharply 
twisting  the  bandage  on  itself  a  half  turn.  The  edges  are 


FIG.  22. — TWISTED  BANDAGE.  FIG.  23. — KNOTTED  BANDAGE. 

thus  drawn  in  and  it  more  closely  embraces  the  part.  Thus, 
in  children,  where  the  frontal  eminences  are  marked,  by 
twisting  the  bandage,  as  seen  in  figure  22,  it  grasps  the 
occipital  protuberance  behind  and  the  frontal  eminences  in 
front.  This  principle  may  be  made  use  of  in  confining  small 
dressings  to  the  top  of  the  head  for  scalp  wounds,  etc. 

THE  KNOTTED  BANDAGE 

This  is  made  with  a  double  roller.     The  body  or  middle 
portion  of  the  bandage,  that  between  the  two  rolls,  is  placed 


2  2  BANDAGING 

on  a  part,  say  one  temple,  and  the  bandage  carried  around 
to  the  opposite  side.  The  two  portions  of  the  bandage  pass 
each  other  and  are  continued  around  to  the  point  of  start- 
ing, where  they  are  turned  at  right  angles  to  their  former 
course,  thus  forming  a  cross  with  a  knot  at  the  point  of 
crossing  (Fig.  23).  They  are  then  continued  around  to  the 
opposite  side,  and  there  fastened  or  else  carried  on  to  form  a 
second  knot  behind  the  first.  The  use  of  this  bandage  has 
usually  been  confined  to  the  temporal  region,  but  the  same 
principle  is  applicable  to  other  portions  of  the  head.  Thus, 
the  knot  may  be  placed  lower  down  and  a  good  bandage 
made  for  covering  both  eyes,  or  still  lower  to  cover  the 
upper  or  lower  lip. 

Gamgee's  Method. — Mr.  Sampson  Gamgee,  of  Birmingham,  proposed 
a  method  of  bandaging  by  means  of  "a  succession  of  intersecting  spirals 
or  figures  of  8"  without  reverses.  He  describes  it  as  follows  ("Treat- 
ment of  Wounds  and  Fractures,"  p.  308):  "To  bandage  a  left  leg  and 
foot,  by  way  of  illustration,  begin  just  above  the  malleoli  with  a  couple 
of  circular  turns,  then  over  the  instep,  obliquely  from  left  to  right; 
make  a  circular  turn  at  the  root  of  the  toes,  and  wind  obliquely  upward 
from  the  inner  side  of  the  foot,  in  front  of  the  ankle,  to  the  back,  and 
thence  up  the  front  of  the  leg,  with  a  long  spiral  to  reach  the  knee-joint; 
below  this  make  a  couple  of  circular  turns;  thence  downward  and  up- 
ward, by  long  intersecting  spirals  or  figures  of  8,  until  every  part,  the 
heel  included,  is  smoothly  covered.  This  method  is  applicable,  with 
trifling  variations  of  detail,  to  all  parts  of  the  body,  so  as  to  exercise  the 
most  equable  and  comfortable  pressure,  without  ruck  or  reverse,  and 
without  danger  of  slipping."  In  my  hands  this  method  consumes  such 
a  large  amount  of  bandage  that  I  prefer  using  either  the  figure  8  of  the 
lower  extremity,  shown  in  figure  47,  or  the  same  bandage  with  a  reverse 
made  in  the  upper  loop  of  the  figure  8  turn  on  the  back  of  the  leg. 

THE  SPECIAL  ROLLER  BANDAGES 
BANDAGES  OF  THE  UPPER  EXTREMITY 

Spiral  of  the  Finger  (Fig.  24). — To  cover  a  finger  which 
has  been  enveloped  by  a  dressing  a  plain  spiral  bandage  is 


SPIRAL   REVERSED    OF    THE    FINGER 


usually  best,  but  reverses  are  necessary  if  the  bare  finger  is 
to  be  bandaged.     Bandage,  i  inch  wide. 

The  initial  extremity  being  laid  lengthwise  on  the  dressing, 
one  or  two  recurrent  turns  are  made  over  the  end  of  the  fin- 
ger. The  bandage  is  then  reversed  3,nd  carried  spirally  up 


FIG.  24. — SPIRAL    BANDAGE    OF 
THE  FINGER. 


FIG.  25. — SPIRAL    REVERSED    BAN- 
DAGE OF  THE  FINGER. 


the  finger  from  its  extremity  to  the  web,  where  it  is  either 
pinned  as  seen  in  figure  24,  or  split  and  the  two  ends  tied 
about  the  part,  or  tied  around  with  a  thread. 

If  the  injury  does  not  extend  above  the  end  joint,  it  is  not  necessary 
to  carry  the  bandage  beyond  the  root  of  the  finger.  When,  however,  the 
middle  or  proximal  bone  is  injured,  then  it  is  better  to  prolong  the  band- 
age up  around  the  wrist  as  in  the  following  bandage. 

Spiral  Reversed  of  the  Finger  (Fig.  25). — Bandage,  3 
yards  X  i   inch. 

Supposing  the  middle  portion  to  be  the  injured  part,  the 


24  BANDAGING 

bandage  is  fixed  by  two  circular  turns  around  the  wrist.  It 
is  then  brought  diagonally  over  the  back  of  the  hand  to  the 
root  of  the  injured  finger,  descending  by  a  spiral  turn  to  its 
tip,  where  a  circular  turn  is  made.  The  finger  is  then  as- 
cended by  spiral  reversed  turns  and  the  bandage  finished  by 
being  carried  across  the  back  of  the  hand  and  fixed  around 
the  wrist  (see  Fig.  25)  or  brought  down  and  ended  around 
the  finger. 

Spica  of  the  Thumb  (Fig.  26). — Bandage,  3  yards  X  i 
inch. 

The  initial  extremity  having  been  fixed  by  one  or  two 
turns  around  the  wrist,  the  bandage  is  carried  downward 


FIG.  26. — SPICA  OF  THE  THUMB. 

across  the  back  of  the  hand  and  wound  in  a  rapid  spiral 
around  the  thumb  until  near  its  extremity.  A  circular  and 
one  or  two  slow  spiral  turns  are  then  made  and  the  bandage 
continued  by  successive  ascending  figure  8  turns  overlap- 
ping each  other  half  their  width  and  made  alternately 
around  the  thumb  and  around  the  hand.  The  thumb  being 
covered,  the  bandage  is  ended  around  the  wrist  (Fig.  26). 
The  bandage  should  not  extend  farther  forward  than  the 
middle  of  the  thumb  nail,  and  the  figure  8  turns  should  com- 
mence when  the  lower  edge  of  the  bandage  arrives  at  the 
web  of  the  thumb.  It  is  not  necessary  to  concentrate  the 
figure  8  turns  all  at  one  point  on  the  side  of  the  wrist,  but 
they  may  be  made  nearly  or  quite  parallel,  as  shown  in  the 
illustration. 


DEMI- GAUNTLET  2$ 

Demi -gauntlet  (Fig.  27). — Bandage,  3  yards  X  i  inch. 

The  initial  extremity  is  fixed  by  a  couple  of  circular  turns 
around  the  wrist.  Then,  if  the  left  hand  is  to  be  bandaged, 
the  roller  is  carried  from  the  ulnar  or  little  finger  side  of  the 
wrist  obliquely  across  the  palmar  surface  to  the  outer  side 


FIG.  27. — THE  DEMI-GAUNTLET. 

and  a  turn  taken  around  the  root  of  the  thumb.  The  band- 
age is  then  carried  obliquely  across  the  back  of  the  hand  to 
the  ulnar  side  of  the  wrist,  thence  back  across  the  palm,  and 
on  arriving  at  the  thumb  side  it  is  again  brought  downward 
to  encircle  the  root  of  the  index  finger  and  thence  up  to  the 


26 


BANDAGING 


ulnar  side  of  the  wrist.  These  figure  8  turns  are  made  alter- 
nately around  the  fingers  and  wrist  until  all  are  encircled 
and  the  back  of  the  hand  covered.  The  bandage  is  ended 
around  the  wrist. 

The  Gauntlet  (Fig.  28). — Bandage,  5  yards  X  i  inch. 


FIG.  28. — THE  GAUNTLET. 


The  initial  extremity  is  fixed  around  the  wrist  and,  if  the 
left  hand  is  to  be  bandaged,  the  roller  is  carried  across  the 
palm  of  the  hand  to  the  base  of  the  thumb.  This  is  de- 
scended by  a  rapid  spiral  turn  to  its  extremity,  and  covered 
by  spiral  or  reversed  turns.  When  the  web  of  the  thumb  is 


SPIRAL   REVERSED   OF    THE    UPPER   EXTREMITY  27 

reached,  the  roller  is  carried  back  across  the  hand  to  its 
ulnar  or  little  finger  side  and,  a  turn  being  made  around  the 
wrist,  the  bandage  is  brought  from  its  thumb  or  radial  side 
down  across  the  back  of  the  hand  to  bandage  the  index 
finger  in  the  same  manner.  The  fingers  and  thumb  are  thus 
covered  one  after  another,  a  figure  8  turn  being  made  around 
the  wrist  for  each  finger.  We  thus  have  all  the  fingers 
covered  by  spiral  or  reversed  turns  and  the  back  of  the  hand 
covered  by  the  figure  8  turns,  of  which  one  loop  encircles 
the  root  of  the  finger  and  is  the  accessory  loop,  while  the 
other  or  principal  one  goes  around  the  wrist. 


FIG.  29. — SPIRAL  REVERSED  OF  THE  UPPER  EXTREMITY. 

Another  method  sometimes  described  as  the  gauntlet  consists  in 
bandaging  the  fingers  as  already  described  and  then  covering  the  hand 
by  slow  spiral  turns,  from  the  web  of  the  fingers  to  the  wrist-joint. 
Jamain  et  Terrier  correctly  call  this  bandage  the  spiral  of  the  hand. 

Spiral  Reversed  of  the  Upper  Extremity  (Fig.  29). — Band- 
age, 6  yards  X  2%  inches.  To  bandage  the  right  arm. 

Hand. — The  initial  extremity  is  placed  obliquely  on  the 
wrist  and  fixed  by  one  or  two  turns,  as  shown  for  the  leg  in 
figure  1 1 .  The  bandage  is  then  carried  over  the  back  of  the 
hand  to  the  web  of  the  thumb  and  index  finger,  thence  to  the 


28 


BANDAGING 


outer  side  of  the  little  finger,  the  lower  edge  of  the  bandage 
crossing  the  hand  at  the  level  of  the  second  joint  of  the  ring 
finger.  (See  Fig.  30.)  A  circular  turn  is  made  at  this 
point,  the  bandage  being  carried  around,  and  as  it  crosses 
the  little  finger  for  the  second  time,  it  covers  only  one-half  of 
the  previous  circular  turn  (Fig.  31).  It  is  then  carried  ob- 
liquely upward  across  the  back  of  the  hand  to  the  knuckle  of 


FIG.  30. — COVERING  THE  HAND. 
FIRST  TURN  AROUND  THE  FINGERS. 


FIG.  31. — COVERING  THE  HAND,  SECOND 
TURN  PASSING  OBLIQUELY  UPWARD 
ACROSS  THE  BACK. 


the  thumb  (Fig.  31).  Returning  across  the  palmar  surface 
again  to  the  ulnar  side,  another  turn  is  taken  around  the 
hand  below  the  thumb,  covering  as  it  passes  over  the  index 
finger  one-half  of  the  circular  turn,  and  the  bandage  again 
brought  to  the  ulnar  side,  as  seen  in  figure  32.  Alternate 
turns  are  thus  made  around  the  hand  above  and  below  the 
thumb,  until  it  is  covered  in  by  two  or  three  figure  8  turns, 


SPIRAL  REVERSED   OF  THE  UPPER  EXTREMITY  2Q 

each  of  which  overlaps  the  preceding  one-half  of  its  width. 
The  points  of  crossing  should  be  near  the  middle  of  the  hand 
and  be  kept  as  much  as  possible  in  the  same  straight  line. 
The  last  turn  below  the  thumb  should  fit  well  up  between 
the  thumb  and  forefinger,  the  bandage  wrinkling  at  this 
point. 


FIG.  32. — COVERING  THE  HAND;  COMPLETING  THE  BANDAGE. 

It  is  sometimes  taught  to  cover  the  hand  by  two  or  three  spiral 
reversed  turns  before  proceeding  to  the  figure  8  ones.  As  these  reverses 
are  easily  displaced  and  are  not  absolutely  necessary,  it  is  better  to 
dispense  with  them.  Prof.  H.  H.  Smith  ("Surgery,"  1863)  also  taught 
to  bandage  the  hand  without  them. 

Forearm. — The  bandage  is  then  carried  up  the  wrist  and 
forearm  by  three  or  four  slow  spiral  turns,  and  reverses 
made  when  the  arm  increases  in  size.  (See  Fig.  33.)  These 
reverses  are  continued  until  within  five  inches  of  the  elbow. 
They  should  then  be  discontinued,  and,  the  forearm  being 
flexed,  the  bandage  carried  directly  over  the  point  of  the 


30  BANDAGING 

elbow,  the  point  of  the  olecranon  being  in  the  middle  of 
the  bandage.  (See  Fig.  33.)  Thence  it  is  brought  back 
to  the  forearm,  covering  in  one-half  of  the  last  turn  (turn 
3,  Fig.  34)  and  carried  again  around  the  lower  portion  of 
the  arm  (turn  4,  Fig.  34),  the  lower  edge  of  the  bandage 
being  just  above  the  point  of  the  olecranon,  and  therefore 
covering  in  one-half  of  turn  2.  The  bandage  is  then  con- 
tinued up  the  arm  (turn  5). 


FIG.  33. — SPIRAL  REVERSED  OF  THE  FOREARM  AND  BEGINNING  OF  THE  FIGURE 
8  OF  THE  ELBOW. 


Arm. — The  bandage  is  then  passed  around  the  arm,  as- 
cending it  in  slow  spiral  or  spiral  reversed  turns,  as  required. 

The  completed  bandage  is  shown  in  figure  29,  page  27. 

When  the  elbow  is  not  much  flexed,  three  turns  may  be 
sufficient  to  cover  it,  as  shown  in  figure  34,  otherwise  five 
may  be  required. 

It  will  be  seen  from  this  that  the  elbow  is  covered  in  by  figure  8  turns, 
the  upper  loop  in  each  being  around  the  arm  and  the  lower  loop  around 
the  forearm,  the  point  of  crossing  being  the  bend  of  the  elbow.  The 
turns  which  are  lowest  on  the  forearm  are  also  lowest  on  the  arm. 


FIGURE   8   OF   THE   UPPER   EXTREMITY  31 

Another  good  method  consists  in  fixing  the  initial  extremity  by  two 
or  three  circular  turns  around  the  point  of  the  elbow  and  then  making 
successive  figure  8  turns  above  and  below  the  joint,  receding  from  the 
point  of  the  elbow  up  the  arm  and  down  the  forearm. 

Some  authors  (E.  Fischer,  "Allgemeine  Verbandlehre;"  Leonard, 
"Bandaging")  advise  using  figure  8  turns  which  begin  at  a  distance 
and  approach  the  joint,  the  last  turn  (instead  of  the  first)  passing  over 


FIG.  34. — FIGURE   8   OF  THE   ELBOW,    COMPLETED. 


the  point  of  the  olecranon.  The  turn  of  the  bandage  most  liable  to 
displacement  is  that  which  passes  over  the  point  of  the  olecranon  process. 
As  this  is  secured  by  other  turns  of  the  bandage  in  the  previously  men- 
tioned methods,  they  are  to  be  preferred. 


Figure  8  of  the  Upper  Extremity  (Fig.  35). — Bandage,  8 
or  9  yards  X  2%  inches. 

The  hand  and  wrist  having  been  covered  in  by  figure  8 
and  slow  spiral  turns,  as  already  described,  the  bandage  is 
inclined  up  the  arm  and  a  turn  taken  around  it.  It  is  then 
brought  downward  and  another  turn  taken  around  the  part. 
Thus  a  figure  8  turn  is  made  in  which  the  lower  loop  is  the 


32  BANDAGING 


principal  one  and  must  be  made  to  lie  flat  on  the  part,  while 
the  upper  one  is  the  accessory  loop  and  gapes  at  its  lower 
edge  as  seen  in  figure  35.  This  gaping  is  concealed  by  the 
lower  loop  of  the  next  figure  8  turn.  Successive  figure  8 
turns  are  to  be  made,  each  overlapping  the  preceding  one 


PIG.  35. — FIGURE  8   BANDAGE  OF  THE   UPPER  EXTREMITY,   No 
REVERSES    BEING    USED. 


until  the  entire  limb  is  covered,  when  the  bandage  is  com- 
pleted by  one  or  two  circular  turns.  If  it  is  desired  to 
avoid  the  gaping  of  the  upper  turn,  a  reverse  may  be  made 
on  the  under  side  of  the  limb,  and  both  loops  will  then  lie 
flat. 

When  a  very  secure  bandage  is  desired,  this  one  may  be  used.  On 
account  of  the  arm  being  carried  in  a  sling,  there  is  not  the  same  tendency 
for  the  bandage  to  become  displaced  as  exists  in  the  lower  extremity. 
If  it  is  desired  to  have  the  arm  flexed,  the  bandage  should  be  applied 
while  it  is  in  that  position  and  it  is  not  to  be  bandaged  while  straight 
and  afterward  bent.  By  so  doing  the  bandage  is  tightened  at  the  flexure 
of  the  elbow  and  interference  with  the  circulation  results. 

Spica  of  the  Shoulder  (Ascending,  Fig.  36). — Bandage,  8 
yards  X  2 finches. 

The  initial  extremity  is  fixed  around  the  arm  at  its  middle. 
One  or  two  spiral  or  spiral  reversed  turns  are  made  until  the 
bandage  reaches  the  axillary  folds.  It  is  then  carried 
around  the  chest,  through  the  opposite  axilla  or  armpit, 


SPICA  OF   THE   SHOULDER 


33 


and  returned  to  the  arm,  where  it  crosses  the  previous  turn 
on  the  outer  side  midway  between  the  anterior  and  posterior 
surfaces.  Another  turn  is  made  around  the  humerus  and 
then  again  around  the  body.  Several  turns  are  thus  made 
around  the  arm  and  through  the  opposite  axilla,  the  points 
of  crossing  being  in  line  with  the  tip  of  the  shoulder.  The 


FIG.  36. — SPICA  OF  THE  SHOULDER.     FIG.  37. — FIGURE  8  BANDAGE  OF  THE 

SHOULDER   AND   AXILLA. 


successive  turns  rise  higher  and  higher,  overlapping  each 
other  one-half  to  two-thirds  the  width  of  the  bandage,  until 
the  shoulder  is  entirely  covered.  (See  Fig.  36.) 

If  the  turns  around  the  body  are  begun  before  the  axillary  folds  are 
reached,  the  arm  will  be  unduly  bound  to  the  side.  These  turns  all 
concentrate  themselves  at  a  single  point  in  the  sound  axilla,  radiating 
from  it  like  a  fan  both  on  the  front  and  back  of  the  chest.  In  applying 
this  bandage  the  operator  should  stand  exactly  at  the  side  of  the  patient 
and  neither  toward  the  front  nor  back.  If  this  is  neglected  the  points 

3 


34  BANDAGING 

of  crossing  of  the  turns  over  the  affected  shoulder  are  apt  to  be  thrown 
too  far  forward  or  backward,  thus  making  an  insecure  dressing.  The 
bandage  has  a  tendency  to  become  displaced  by  the  points  of  crossing 
slipping  down  either  in  front  or  behind  the  shoulder.  It  is  to  avoid 
this  that  they  should  always  be  made  in  the  median  line  of  the  arm. 
When,  instead  of  the  figure  8  turns  being  begun  below  and  made  to 
ascend  successively  higher  and  higher,  as  in  the  ascending  spica  just 
described,  they  are  commenced  high  up  on  the  neck  and  made  to 
descend,  then  the  bandage  is  called  the  descending  spica.  It  is  preferred 
by  some  authors,  but  in  this  country  the  ascending  is  the  more  popular. 
Goffre"s  ("Precis  iconographique  des  bandages,"  Paris,  1854)  prefers 
the  descendant,  as  he  claims  it  to  be  more  solid  and  regular  than  the 
ascendant. 

Figure  8  of  the  Shoulder  and  Axilla  (Fig.  37). — Bandage, 
3  yards  X  2^  inches. 

The  initial  extremity  being  placed  on  top  of  the  shoulder 
of  the  affected  side,  the  bandage  is  carried  under  the  affected 
axilla  and  up  over  the  shoulder,  crossing  the  initial  ex- 
tremity. From  there  it  is  carried  under  the  axilla  of  the 
opposite  side  and  back  again  to  the  affected  shoulder. 
Two  or  three  figure  8  turns  composed  of  alternate  loops  under 
the  two  axillae  and  crossing  on  the  shoulder  of  the  affected 
side  constitute  the  bandage.  The  turns  cover  each  other 
one-half  to  two-thirds  of  their  width.  (See  Fig.  37.)  The 
extremity  may  be  pinned  where  the  bandage  finishes  or 
may  be  wound  around  the  arm. 

If  preferred,  instead  of  carrying  the  bandage  to  the  oppo- 
site axilla,  it  may  be  passed  around  the  neck,  making  a 
figure  8  bandage  of  the  neck  and  axilla.  It  is  a  useful  bandage 
to  retain  dressings  in  the  axilla. 

BANDAGES  OF  THE  LOWER  EXTREMITY 

Spiral  Reversed  of  the  Lower  Extremity  (Figs.  38  and 
39). — Bandage,  two  rollers,  each  7  yards  X  2^  inches. 

The  initial  extremity  of  the  bandage  is  placed  obliquely 
across  the  ankle-joint  and  fixed  by  one  or  two  turns,  as 


SPIRAL   REVERSED   OF   THE   LOWER   EXTREMITY 


35 


shown  in  figure  38.  The  bandage  is  then  carried  (if  on  the 
left  foot)  down  the  outer  side  of  the  foot,  obliquely  across 
the  sole  to  the  ball  of  the  big  toe,  and  over  across  the  root  of 
the  toes,  but  not  encroaching  on  them  (see  (Fig.  39) ;  thence 
around  the  outer  border  of  the  foot  and  again  across  the  sole 
to  the  inner  side.  The  bandage  being  carried  on  the  instep, 
a  reverse  is  made.  If  necessary,  this  is  repeated  and  the 


FIG.  38. — FIXING  THE  INITIAL 
EXTREMITY. 


FIG.  39. — SPIRAL  REVERSED  BANDAGE 
OF  THE  LOWER  EXTREMITY. 


next  turn  brought  up  around  the  ankles,  encircling  them  low 
down.  From  here  it  proceeds  down  around  the  foot  and 
again  up  around  the  ankle,  whence  it  proceeds  in  slow  spiral 
turns  up  the  leg.  We  thus  have  the  foot  covered  in  by  first 
a  circular  turn,  then  from  one  to  three  spiral  reversed  turns 
according  to  its  length  and  the  width  of  the  bandage,  and 
finally  a  couple  of  figure  8  turns  around  the  ankle.  Each 
turn  covers  the  preceding  one-half  its  width.  After  two  or 
three  slow  spiral  turns  the  leg  begins  to  increase  in  diameter 


BANDAGING 


and  reverses  are  again  necessary.  These  are  made  as  long 
as  the  leg  increases  in  size,  but  when  the  point  of  greatest 
circumference  is  reached,  the  reverses  are  stopped  and  the 
bandage  completed  by  slow  spiral  turns.  If  it  is  desired  to 
cover  the  knee  and  thigh  also,  the  leg  being  in  an  extended 
position,  when  the  lower  border  of  the  patella  or  knee-cap  is 
reached,  the  bandage  is  passed  directly 
across  it  (Fig.  40).  The  next  turn  is 
then  made  over  the  upper  half  of  the 
patella,  covering  in  one-half  of  the  pre- 
ceding turn,  and  then  over  the  lower 
half,  covering  the  remainder  of  the 
turn  over  the  patella.  The  bandage 
is  then  carried  up  the  thigh  by  regular 
spiral  or  reversed  turns. 

When  the  foot  is  short  or  the  band- 
age broad,  it  is  not  necessary  to  make 
any  reverses,  and  the  figure  8  turns 
should  be  commenced  immediately 
after  the  circular  turn  around  the  root 
of  the  toes  has  been  made.  The  first 
figure  8  turn  encircles  the  ankles  low 
down,  leaving  the  heel  exposed;  alter- 
nate turns  are  then  taken  around  the 
foot  and  the  ankle,  those  on  the  foot 
approaching  the  heel  and  those 
around  the  ankle  ascending  the  leg,  each  being  half  the 
width  of  the  bandage  higher  than  the  preceding  one.  As 
with  the  hand,  so  with  the  foot,  it  is  always  better  to  dis- 
pense with  reverses  when  possible. 

To  Cover  ike  Heel. — If  it  is  desired  to  cover  the  heel,  either 
the  spiral  of  the  heel  or  spica  of  the  foot  can  be  used. 

The  former  was  called  by  the  late  Dr.  Chas.  T.  Hunter  the 
"American  spiral"  (Ashhurst's  "International  Encyclo- 
pedia of  Surgery,"  vol.  i).  It  was  so  named  not  because  of 
its  American  origin,  for  the  turn  which  is  peculiar  to  it  is 


FIG.  40. — FIGURE  8  OF 
THE  KNEE. 


SPIRAL  OF   THE  HEEL 


37 


seen  in  Galen  and  many  of  the  older  French  works,  and  it  is 
also  known  in  Great  Britain  and  Germany,  but  because  it 
was  recognized  and  used  more  by  the  Americans  than  any 


FIG.  41. — SPIRAL  OF  THE  HEEL.     FIRST     FIG.  42. — SECOND  TURN  ACROSS  THE 
TURN  OVER  THE  POINT.  RIGHT  SIDE  OF  THE  HEEL. 

others ;  also  because  it  has  been  taught  continuously  here  for 
more  than  thirty-five  years,  while  even  yet  it  is  compara- 
tively seldom  mentioned  in  the  foreign  works  on  surgery.  It 
is  applied  as  follows,  a  bandage  2j^  inches  wide  being  used: 


FIG.  43. — SECOND  TURN  ACROSS  THE 
RIGHT  SIDE  OF  THE  HEEL. 


FIG.  44. — COMPLETED    SPIRAL 
BANDAGE  OF  THE  HEEL. 


Spiral  of  the  Heel  (Figs.  41,  42,  43,  and  44). — To  bandage 
the  left  foot. 

The  initial  extremity  having  been  fixed  around  the  foot  or 


BANDAGING 


ankle,  the  bandage  is  carried  under  the  sole  of  the  foot  to  its 
inner  side.  A  circular  turn  is  then  made,  the  lower  edge  of 
the  bandage  not  coming  farther  forward  than  the  root  of  the 
toes.  The  foot  is  ascended  by  one  or  two  spiral  reversed 
turns  until  the  top  of  the  instep  is  reached.  Thence  it  is 
taken  directly  over  the  point  of  the  heel,  returning  to  the 
place  of  departure  on  the  instep  (Fig.  41) ;  it  is  then  carried 
down  the  outer  side  of  the  foot  (Fig.  42)  to  the  sole  and 
transversely  across  the  inner  surface  of  the  heel  (Fig.  43) 
behind  the  tendo  Achillis,  and  back  again  to  the  instep 
(Fig.  42).  From  the  instep  it  is  next  carried  down  the 
inner  side  of  the  foot,  under  the  sole,  and  transversely 
across  the  outer  surface  of  the  heel,  behind  the  tendo 


FIG.  45. — SPICA  OF  THE  FOOT, 
THE  FIRST  FIGURE  8  TURN  GOING 
OVER  THE  HEEL. 


FIG.  46. — SPICA   OF   THE  FOOT, 
COMPLETED. 


Achillis  and  up  in  front  of  the  ankle-joint,  whence  it  pro- 
ceeds up  the  leg  (Fig.  44).  A  pin  is  then  inserted  on  each 
side  of  the  heel  where  the  transverse  turns  cross  the  turn 
going  over  the  point. 

Spica  of  the  Foot  (Figs.  45  and  46). — Bandage,  6  or  7 
yards  X  2  inches. 

The  initial  extremity  being  fixed  by  two  circular  turns  at 
the  root  of  the  toes,  the  bandage  is  inclined  upward  and  car- 
ried across  the  instep  and  directly  over  the  point  of  the  heel. 
From  there  it  is  brought  back  to  the  instep  and  carried 
around  the  foot,  covering  in  two- thirds  of  the  preceding  turn. 


FIGURE   8   OF   THE   LOWER   EXTREMITY 


39 


(See  Fig.  45.)  Another  turn  is  then  made  around  the  heel, 
covering  two- thirds  of  the  first  turn  over  its  point.  Succes- 
sive turns  are  then  taken  around  the  foot  and  around  the 
back  of  the  heel,  those  on  the  foot  approaching  the  heel 
(turns  i,  3,  5,  7,  9),  and  those  back  of  the  heel  ascending  the 
leg  (turns  2,  4,  6,  8,  10).  (See  Fig.  46.) 

On  account  of  the  tendency  of  the  turns  over  the  heel  to 
displace  themselves  by  slipping  up  on  the  tendo  Achillis,  it 
is  best  to  apply  padding  at  this  point,  also  beneath  the  mal- 
leoli.  By  this  means  the  turns  are  rendered  more  secure 
and  the  prominent  malleoli  are  protected  from  pressure.  It 
is  usually  impracticable  to  bring 
the  turns  around  the  foot  so  far  up 
as  to  meet  the  first  turn  over  the 
heel;  therefore  a  small  space  is 
often  left  uncovered  on  the  sole  of 
the  foot  at  this  point.  If  properly 
applied  with  padding  over  the 
tendo  Achillis,  this  makes  a  neat 
and  moderately  secure  bandage. 

Figure  8  of  the  Lower  Extremity 
(Fig.  47). — The  lower  extremity 
can  be  covered  without  any  re- 
verses by  employing  the  figure  8 
bandage.  The  figure  8  turns  are 
made  wherever  reverses  would 
otherwise  be  used.  When  the  leg 
begins  to  increase  in  diameter  so 
that  the  plain  slow  spiral  turns  no 
longer  lie  flat,  then  the  bandage  is 
inclined  upward  and  a  turn  taken 

around  the  leg;  the  roller  being  brought  down  crosses  the 
first  turn  a  little  to  the  outside  of  the  sharp  edge  of  the 
shin  bone.  The  upper  and  lower  turns  are  separated  on 
the  back  of  the  leg  by  an  interspace,  and  each  turn  is  made 
to  cover  the  upper  half  of  the  previous  one.  (See  Fig.  47.) 


FIG.  47. — FIGURE  8  BANDAGE 
OF  THE  LOWER  EXTREMITY. 


40  BANDAGING 

The  lower  loop  applies  itself  flat  on  the  surface  of  the  part, 
while  the  upper  one  only  touches  it  by  its  upper  edge,  the 
lower  edge  gaping  widely,  as  shown  in  figure  47.  No  atten- 
tion is  to  be  paid  to  the  upper  turn,  as  it  is  entirely  covered 
by  the  succeeding  lower  ones.  Continue  these  figure  8 
turns  until  the  leg  ceases  to  increase  in  size,  then  ascend  to 
the  knee-joint  by  two  or  three  slow  spiral  turns.  If  de- 
sired, the  knee  can  be  covered  by  the  same  figure  8  turns  as 
were  applied  to  the  leg,  and  the  bandage  continued  in  the 
same  manner  up  the  thigh. 

This  bandage  is  much  admired  and  employed.  Its  chief  value  lies 
in  its  security  from  displacement,  and  when  patients  are  compelled 
to  use  the  limb  much,  it  can  be  employed  with  advantage.  Its  disadvan- 
tages are  that  it  requires  a  larger  amount  of  bandage  than  the  spiral 
reversed  and  covers  the  part  with  many  thicknesses  of  material.  It 
uses  from  fifty  to  one  hundred  per  cent,  more  bandage  than  the  spiral 
reversed,  according  to  the  amount  of  overlapping.  In  bandaging  the 
leg  up  to  the  knee,  as  there  are  only  five  or  six  reverses  made,  using  the 
figure  8  turns  instead  would  add  a  couple  of  yards  to  the  total  length  of 
the  bandage.  In  patients  confined  to  bed  the  spiral  reversed  is  usually 
secure  enough.  By  making  a  reverse  on  the  under  side  of  the  limb  in 
the  upper  loop  its  gaping  may  be  avoided  and  the  bandage  will  lie 
flat  on  the  part  through  its  entire  length. 

In  bandaging  the  leg  between  the  ankle  and  the  knee  about  ten  turns 
are  needed.  Three  turns,  plain  spiral  in  character,  are  used  to  cover  its 
lower  portion  above  the  ankle.  This  part  is  practically  a  cylinder.  It 
does  not  increase  sufficiently  in  size  to  require  a  sudden  change  in  the 
direction  of  the  bandage  to  make  it  lie  flat,  therefore  it  is  positively 
wrong  to  make  reverses  here,  and  it  is  unnecessary  to  make  figure  8 
turns.  Plain  slow  ascending  spiral  turns  are  best.  The  same  condition 
exists  from  the  largest  part  of  the  calf  of  the  leg  to  the  knee-cap  or  bend 
of  the  knee.  Here  the  decrease  in  size  is  so  small  that  the  part  can  also 
be  treated  as  a  cylinder  and  bandaged  like  the  part  just  above  the 
ankle  with  three  slow  ascending  spiral  turns.  Here,  likewise,  reverses 
are  positively  wrong  and  figure  8  turns  unnecessary.  The  remaining 
portion,  embracing  approximately  the  middle  half  of  the  leg,  increases 
so  rapidly  in  size  that  it  forms  a  cone  which  requires  a  special  mode  of 
applying  the  bandage  in  order  to  make  the  turns  lie  flat  on  the  part. 
This  is  accomplished  either  by  making  reverses  or  figure  8  turns  as 


SPICA   OF   THE    GROIN  4! 

already  described.  If  the  gaping  of  the  upper  loop  of  the  figure  8  turn 
is  objected  to,  it  can  be  avoided  by  making  a  reverse  on  the  back  of  the 
limb.  The  making  of  this  reverse  on  the  back  of  the  limb  can  readily  be 
acquired  by  a  little  practice.  If  it  is  desired  to  make  the  bandage 
especially  secure,  the  figure  8  turns  may  be  made  longer  than  usual. 
By  so  making  them  and  using  a  reverse  on  the  back  of  the  limb  in  the 
upper  loop  we  have  the  best  bandage  for  this  part  of  the  body.  The 
method  of  Gamgee,  by  winding  the  bandage  somewhat  indiscriminately 
up  and  down  the  leg,  has  already  been  alluded  to  (page  22).  Other 
methods  have  been  proposed.  One  consists  in  making  long  figure  8 
loops,  one  below  and  one  above,  approaching  to  the  point  of  greatest 
diameter  of  the  calf,  where  the  bandage  is  ended  by  a  circular  turn. 
Another  consists  in  making  long  figure  8  turns  all  the  upper  loops  of 
which  go  above  the  point  of  greatest  diameter  and  are  passed  once 
circularly  around  the  limb  before  again  coming  down  the  leg  to  form 
the  next  figure  8  turn.  This  consumes  an  unnecessary  amount  of 
bandage,  which  is  massed  around  the  leg  just  below  the  knee-cap. 
Security  from  displacement  of  the  bandage  in  walking  cases  is  to  be 
acquired  either  by  placing  adhesive  strips  obliquely  across  the  turns, 
or  better,  by  having  the  patient  tack  the  turns  together  by  means  of  a 
needle  and  thread. 

To  Bandage  the  Knee. — The  knee  can  be  bandaged  while 
in  a  straight  position,  either  by  the  bandage  described  under 
the  spiral  reversed  of  the  lower  extremity  and  shown  in  fig- 
ure 40,  or  by  that  described  under  the  figure  8  bandage  of 
the  lower  extremity,  preferably  the  former.  When,  how- 
ever, it  is  desired  to  cover  it  while  in  a  slightly  flexed  posi- 
tion, three  turns  may  not  be  sufficient  and  five  may  be 
required. 

Spica  of  the  Groin. — Ascending  (Fig.  48). — Bandage,  8 
yards  X  3  inches. 

The  initial  extremity  is  fixed  by  two  circular  turns  around 
the  thigh,  well  up  to  the  perineum  or  crotch.  If  the  right 
groin  is  to  be  bandaged,  on  reaching  the  outer  surface  of  the 
thigh,  the  roller  is  inclined  obliquely  upward  and  carried 
across  the  pubes  to  the  top  of  the  left  thigh-bone,  thence 
horizontally  across  the  back,  around  the  upper  edge  of  the 
right  thigh-bone,  and  down  parallel  with  the  fold  in  the 


42  BANDAGING 

groin,  crossing  the  first  turn  slightly  to  the  inner  side  of  the 
median  line  of  the  thigh,  taking  care  to  leave  no  point  un- 
covered between  the  circular  and  oblique  turns.  It  then  passes 
around  the  thigh  to  its  outer  side,  covering  in  one-half  of 
the  previous  turn.  Two  or  more  additional  figure  8  turns 
are  then  made,  each  parallel  to  the  first  and  covering  the 
previous  turn  one-half.  The  last  turn  encircles  the  crest 
of  the  hip-bone.  (See  Fig.  48.) 


FIG.  48. — SPICA  BANDAGE  OF  THE  GROIN. 

The  point  of  crossing  being  the  essential  part,  care  should  be 
taken  that  it  is  not  cast  too  far  out,  thus  making  a  spica  of  the  hip 
rather  than  a  spica  of  the  groin.  The  turns  around  the  body  should 
encircle  the  pelvis  and  not  the  abdomen  above  the  iliac  crests.  The 
bandage  is  thus  made  independent  of  and  unaffected  by  the  motion 
which  takes  place  between  the  pelvis  and  the  spine. 

When  the  bandage  is  applied  as  above  described,  it  is  called  the 
ascending  spica,  because  the  turns  cover  the  part  by  ascending  from 
below  upward.  When,  however,  it  is  desired  to  cover  the  part  by 
the  descending  spica,  the  first  turn,  instead  of  beginning  low  down, 
is  passed  high  up  and  each  succeeding  one  is  made  parallel  to  and 
beneath  it  until  the  bandage  is  completed. 


DOUBLE   SPICA  OF   THE   GROIN 


43 


Genre's  says  he  sees  no  reason  to  prefer  one  to  the  other.  When  a 
part  or  dressing  is  to  be  supported,  it  is  better  to  do  it  with  a  turn  which 
passes  from  below  upward  rather  than  to  use  one  from  above  downward. 
For  this  reason  it  is  more  nearly  correct  to  make  the  spicas  by  carrying 
the  bandage  from  the  inner  to  the  outer  side  of  the  limb.  As  this 
necessitates  using  the  left  hand  instead  of  the  right,  an  accomplishment 
possessed  by  few,  the  usual  method  has  been  described  and  illustrated. 

Double  Spica  of  the  Groin  (Figs.  49  and  50). — Bandage, 
two  rollers,  each  6  yards  X  3  inches. 


FIG.  49.  FIG.  50. 

FIGS.  49  AND  50. — DOUBLE  SPICA  BANDAGE  OF  THE  GROIN. 


Fix  the  initial  extremity  by  two  circular  turns  around  the 
right  thigh  well  up  to  the  perineum.  Carry  the  bandage 
from  the  outer  surface  of  the  thigh  obliquely  upward  across 
the  pubes  to  a  point  low  down  on  the  opposite  side  of  the 
waist.  Thence  across  the  back  to  the  same  place  on  the 
patient's  right  side  and  obliquely  downward  to  the  outer 
side  of  the  left  thigh,  crossing  the  former  turn  in  the  median 
line  of  the  body  below  the  umbilicus  or  navel.  Take  a  cir- 
cular turn  around  the  thigh  and,  on  the  arrival  of  the  band- 


44  BANDAGING 

age  at  its  inner  side  for  the  second  time,  bring  it  obliquely 
upward  and  outward  (Fig.  49)  and  carry  it  over  the  most 
prominent  part  of  the  hip  (turn  5,  Fig.  50) ;  then  obliquely 
up  across  the  back  and  around  the  waist  (turn  6).  Thence 
proceed  down  across  the  back  over  the  right  hip  low  down 
(turn  7),  crossing  turn  2  in  the  middle  line  on  the  front  of 
the  thigh ;  carry  it  around  the  thigh  to  its  outer  side  (turn  8), 
half  the  width  of  the  bandage  above  turn  2  and  parallel  to  it. 
Proceed  up  across  the  abdomen,  around  the  body,  and  bring 
the  roller  down  across  the  abdomen  (turn  9),  parallel  to  and 
half  the  width  of  the  bandage  above  turn  3,  around  the  back 
of  the  left  thigh,  upward  and  outward  around  the  left  hip 
(turn  10),  across  the  back  to  the  waist,  around  the  waist 
(turn  n),  then  down  across  the  back  to  the  right  hip,  ob- 
liquely down  over  the  right  groin  (turn  12),  and  end  the 
bandage  either  by  winding  it  around  the  right  thigh  or  tak- 
ing a  turn  around  the  abdomen. 

In  making  the  first  oblique  turn  after  fixing  the  initial  extremity, 
care  should  be  taken  to  keep  it  well  down  on  the  groin  as  otherwise  a 
space  will  be  left  uncovered  between  the  circular  turn  around  the  thigh 
and  the  two  oblique  turns  immediately  above  it.  The  points  of  crossing 
over  the  groins  should  not  be  thrown  too  far  out,  and  those  on  the 
abdomen  should  be  as  near  as  possible  in  the  median  line  of  the  body. 
If,  in  commencing  the  spica  bandages  of  the  groin,  the  initial  extremity 
is  fixed  too  low  down,  then  the  bandage  should  be  carried  up  by  spiral 
or  spiral  reversed  turns  until  its  upper  edge  nearly  or  quite  touches  the 
perineum.  If  this  is  not  done  the  turns  will,  nevertheless,  slip  up  to 
that  point,  thus  loosening  the  bandage.  The  spicas  of  the  groin  can 
also  be  begun  by  fixing  the  initial  extremity  around  the  abdomen,  but 
greater  security  is  obtained  by  fixing  it  on 'the  thigh.  The  double 
spica  can  also  be  made  in  a  descending  manner. 

Crossed  Bandage  of  the  Perineum  (Fig.  51). — Bandage, 
8  yards  X  3  inches.  Fix  the  initial  extremity  high  up  on 
the  left  thigh  (turn  i)  and  continue  it  from  the  under  surface 
of  the  thigh  across  the  perineum  (turn  2)  rather  low  down  on 
the  right  hip  (turn  3);  thence  across  the  back  to  a  similar 


CROSSED  BANDAGE  OF  THE  PERINEUM 


45 


point  on  the  opposite  side  (turn  4)  and  down  in  front  of  the 
left  hip  across  the  perineum,  turn  5  crossing  turn  2  in  the 
middle  line.  The  bandage  is  then  carried  to  the  outer  por- 
tion of  the  thigh  and  up  around  the  waist  (turns  6  and  7). 
Bring  it  down  across  the  back,  around  the  right  hip  (turn  8), 
half  the  width  of  the  bandage  above  turn  3  and  parallel  to  it. 
Continue  across  the  perineum  (turn  9)  in  front  of  turn  2, 
around  the  thigh  to  its  outer  side  (turn  10),  up  around  the 


FIG.  51. — CROSSED   BANDAGE   OF   THE   PERINEUM. 

opposite  side  of  the  waist  (turn  n),  down  across  the  back, 
around  the  left  hip  (turn  12)  half  the  width  of  bandage 
above  turn  4,  across  the  perineum,  around  the  left  hip  and 
waist  (turn  13),  to  end  by  a  couple  of  circular  turns  around 
the  body. 

This  bandage  is  used  to  retain  dressings  to  the  perineum,  particularly 
after  operations,  such  as  external  urethrotomy,  median  lithotomy,  etc. 
The  dressing  can  be  perforated  to  allow  the  drainage-tube  from  the 
bladder  to  protrude.  It  is  more  secure  and  gives  greater  pressure  than 
does  the  four-tailed  sling  often  used  for  similar  purposes. 


46 


BANDAGING 
BANDAGES  OF  THE  HEAD 


In  commencing  a  head  bandage  the  initial  extremity  may 
be  laid  on  one  temple  and  fixed  by  a  couple  of  circular  turns, 
or  it  may  be  made  more  secure  by  applying  it  as  follows :  Al- 
low the  end  of  the  bandage  to  project  down  and  behind  the 
ear  while  a  circular  turn  is  made  around  the  head,  as  seen  in 
figure  5  2 .  The  projecting  end  of  the  bandage  is  then  turned 


FIG.  52.  FIG.  53. 

FIGS.  52  AND  53. — THE  METHOD  OF  FIXING  THE  INITIAL  EXTREMITY  IN  HEAD 

BANDAGES. 


up  and  covered,  as  seen  in  figure  53,  by  the  next  circular 
turn  and  the  bandage  then  proceeded  with. 

The  Monocle  or  Bandage  for  One  Eye  (Fig.  54,  a  and  b). 
—Bandage,  5  yards  X  2  inches. 

To  bandage  the  left  eye :  Place  the  initial  extremity  on  the 
left  temple  and  fix,  by  a  circular  turn,  around  the  head  from 
left  to  right.  On  arriving  for  the  second  time  above  the 
right  ear,  the  bandage  should  be  carried  down  behind  the 
back  of  the  head,  under  the  left  ear  and  cheek  prominence, 
and  up  in  front  of  the  left  eye,  the  lower  edge  crossing  the 
root  of  the  nose.  From  there  it  is  taken  over  the  top  of  the 
side  of  the  head  and  again  to  the  back  of  the  head.  A  sec- 
ond turn  is  made  covering  in  the  preceding  one  half  the 


THE  MONOCLE  OR  BANDAGE  FOR  ONE  EYE  47 

width  of  the  bandage  higher  up  on  the  cheek  (Fig.  54,  a)  and 
lower  down  on  the  head.  A  third  turn,  still  higher  on  the 
cheek  and  lower  on  the  head,  may  be  applied  if  thought  de- 
sirable. The  bandage  is  completed  by  one  or  two  horizon- 
tal circular  turns  around  the  head  (Fig.  54,  b). 

The  tip  of  the  ear  on  the  bandaged  side  should  be  allowed  to  project, 
or  if  covered  it  should  be  protected  from  pressure  by  cotton. 

The  horizontal  turns  should  rest  on  the  cartilages  of  the  ears  and 
cover  each  other  exactly. 

If  the  right  eye  is  to  be  bandaged  the  initial  extremity  should  be 
placed  on  the  left  temple  and  the  bandage  carried  from  the  operator's 
right  to  left  around  the  forehead. 

Among  the  various  ways  of  bandaging  the  eyes  the  follow- 
ing may  be  mentioned :  Instead  of  the  oblique  turns  cross- 
ing at  the  root  of  the  nose,  they  may  all  be  made  parallel  to 


a.  b. 

FIG.  54. — THE  MONOCLE  OR  BANDAGE  FOR  ONE  EYE. 


each  other.  This  can  only  be  done  if  the  bandage  is  either 
very  narrow  or  very  elastic.  Sometimes  a  circular  turn  is 
taken  after  each  oblique  one;  this  is  unnecessary.  The 
French  have  a  way  of  covering  the  eye  by  reversing 
the  oblique  turns  on  the  forehead,  instead  of  carrying 
them  on  over  the  scalp,  but  it  is  too  insecure  to  be 
recommended. 


48  BANDAGING 

Binocle  or  Bandage  for  Both  Eyes. — When  both  eyes  are 
to  be  bandaged  it  can  be  done  with  either  a  single  or  a 
double  roller. 

Binocle  with  a  Single  Roller  (Fig.  55). — The  initial  ex- 
tremity being  fixed  around  the  forehead,  the  left  eye  is 
bandaged  as  already  described  above.  After  the  finishing 
circular  turn  has  been  made  it  is  pinned  at  the  back  of  the 
head,  and  the  roller  brought  upward  over  the  left  side  of  the 
head,  down  across  the  root  of  the  nose,  and  over  the  un- 
covered right  eye. 


FIG.  55. — BINOCLE  OR  BANDAGE  FOR  BOTH  EYES. 

This  is  covered  by  two  or  three  radiating  turns,  precisely 
as  was  done  to  the  left  eye,  only  instead  of  the  body  of  the 
bandage  being  carried  upward  from  the  face  over  the  scalp 
it  is  carried  downward  from  the  scalp  over  the  eye.  The 
bandage  is  completed  by  one  or  two  horizontal  circular 
turns  (Fig.  55). 

Binocle  with  a  Double  Roller. — The  middle  of  the  band- 
age is  placed  on  the  forehead  and  the  two  rolls  carried 
around  immediately  above  the  ears,  crossed  at  the  back  of 
the  head,  and  each  brought  forward  under  the  correspond- 
ing ear,  then  up  over  the  eyes,  crossing  at  the  root  of  the 
nose,  over  the  sides  of  the  head,  crossing  again  at  the  back 
of  the  head,  then  forward  over  the  eyes,  covering  one-half 
the  preceding  turn,  crossing  again  at  the  root  of  the  nose, 


OBLIQUE  OF  THE  JAW  49 

thence  over  the  side  of  the  head  one-half  the  width  of  the 
bandage  lower  than  the  preceding  turn.  On  arriving  at 
the  back  of  the  head  the  bandage  is  directed  horizontally 
around  the  head  and  finished  by  one  or  two  circular  turns 
made  with  the  longer  end.  If  the  ears  are  to  be  covered 
they  should  be  protected  from  pressure  by  cotton. 

This  bandage  is  more  secure  than  that  made  with  the  single  roller 
and  on  that  account  is  to  be  preferred. 


FIG.  56. — TRANSVERSE  BANDAGE  FOR  ONE  EYE. 

Transverse  Monocle  or  Bandage  for  One  Eye  (Fig.  56). 
— Bandage,  2  yards  X  2^  inches. 

Place  the  initial  extremity  above  the  right  ear  and  fix  by 
two  turns  carried  around  the  head  in  front  of  the  eyes  and 
above  the  ears.  On  arriving  at  the  back  of  the  head  for  the 
second  time,  pin  and  reverse  the  bandage  bringing  over  the 
scalp,  passing  it  down  under  the  horizontal  turns,  and  pull 
it  up  until  the  eye  is  exposed  as  shown  in  figure  56,  when 
the  bandage  is  pinned. 

Oblique  of  the  Jaw  (Figs.  57  and  58). — Bandage.,  5  yards 
X  2  inches. 

To  bandage  the  left  side  of  the  jaw:  Place  the  initial  ex- 
tremity on  the  right  temple  and  fix  by  one  or  two  horizontal 
circular  turns  from  left  to  right.  On  arriving  above  the  left 
ear  the  bandage  is  directed  downward  across  the  back  of  the 


$0  BANDAGING 

neck  (Fig.  57),  under  the  jaw  an£  up  the  left  side  of  the 
face,  the  anterior  edge  of  the  bandage  not  projecting  quite 
so  far  forward  as  the  outer  angle  of  the  eye.  (See  Fig. 
58).  From  there  it  is  carried  over  the  head,  down  back  of 
the  right  ear,  again  under  the  jaw  and  three  or  four  similar 
vertical  turns  made,  each  overlapping  the  preceding  one 
on  the  affected  side,  one-half  to  two-thirds  of  its  width; 
while  on  the  sound  side  behind  the  ear  they  cover  each  other 
exactly  (Fig.  57).  On  the  arrival  of  the  last  turn  above  the 


FIG.  57.  FIG.  58. 

FIGS.  57  AND  58. — OBLIQUE  BANDAGE  OF  THE  JAW. 


right  ear,  the  bandage  is  pinned  and  reversed,  to  be  finished 
by  being  carried  once  or  twice  around  the  head.  Pins 
should  be  inserted  at  the  points  of  crossing  of  the  vertical 
and  horizontal  turns. 

This  is  the  old  single  chevestre  or  halter  bandage  of  the  French  and 
is  intended  for  fractures  of  the  condyle  of  the  lower  jaw  or  for  dressing 
applied  to  the  ear  or  parotid  region.  The  vertical  turns  may  be  carried 
farther  forward  or  backward  according  to  the  necessities  of  the  case. 
Some  surgeons  were  accustomed  to  make  turns  over  the  front  of  the  jaw, 
but  Gerdy  ("Traite  des  Bandages,"  p.  215)  advises  against  this  as 
tending  to  displace  the  fragments  backward.  Others  overlap  the  turns 
from  behind  forward,  as  this  tends  to  push  the  jaw  forward. 


DOUBLE    OBLIQUE    OF   THE   JAW  5 1 

Double  Oblique  of  the  Jaw. — Double  Halter  Bandage  or 
Double  Chevestre.  (Fig.  59.)  This  is  best  made  with  a 
double  roller.  The  same  turns  may  .also  be  made  with  a 
single  roller,  but  it  is  not  so  secure  as  the  former,  although 
more  convenient.  Bandage,  7  yards  X  2  inches. 

Place  the  middle  of  the  bandage  on  the  forehead  and 
carry  both  rollers  to  the  nape  of  the  neck.  Cross  at  this 
point  and  bring  them  forward  under  (not  on)  the  chin, 
cross  again  and  proceed  up  the  sides  of  the  face,  the  ante- 
rior edge  of  the  bandage  coming  as  far  forward  as  the  exter- 


/ 

FIG.  59. — DOUBLE  OBLIQUE  OF  THE  JAW. 


nal  angle  of  the  eye.  On  arriving  on  top  of  the  head, 
the  bandage  is  again  crossed  and  each  roller  returned  to 
the  nape  of  the  neck.  They  are  then  again  brought  for- 
ward under  the  chin,  up  the  sides  of  the  face,  crossed  on 
top  of  the  head,  and  taken  back  to  the  nape  of  the  neck. 
These  turns  may  be  repeated  once  or  twice  if  desired. 
Each  succeeding  turn  as  it  crosses  the  top  of  the  head  is 
slightly  behind  the  one  in  front  of  it.  The  bandage  should 
be  finished  by  a  circular  turn  around  the  forehead.  (See 
Fig-  59-) 

This  is  a  good  bandage  to  retain  dressings  to  both  sides  of  the  face. 
Gerdy  (loc.  cit.,  p.  216)  made  reverses  on  the  top  of  the  head  in  order 
to  make  it  lie  flat.  This  is  hardly  necessary.  He  also  tied  the  ends  at 


52  BANDAGING 

the  back  of  the  neck  instead  of  pinning.    Thillaye,  "  Traite  des  bandages 
et  appareils,"  made  it  with  a  single  roller. 

Recurrent  of  the  Head  (Fig.  60). — Bandage,  5  yards  X  2 
inches. 

Fix  the  bandage  by  two  horizontal  turns.  On  arriving 
at  the  forehead,  a  pin  is  inserted  and  the  bandage  reversed 
and  carried  in  the  median  line  back  to  the  occiput;  here 
it  is  again  pinned  and  brought  forward,  covering  in  one- 
half  of  the  median  turn.  It  is  then  carried  backward  and 


FIG.  60.  —  RECURRENT  BANDAGE  OF      FIG.  61.  —  RECURRENT  BANDAGE  OF 
THE  HEAD,  WITH  SINGLE  ROLLER.       THE  HEAD,  WITH  DOUBLE  ROLLER. 


forward,  first  on  one  side  and  then  on  the  other,  until  the 
scalp  is  covered.  (See  Fig.  60.)  The  bandage  is  completed 
by  one  or  two  horizontal  circular  turns.  Each  antero- 
posterior  turn  may  either  be  pinned  as  it  is  made  or  held 
in  place  by  an  assistant  until  the  bandage  is  completed. 
The  former  way  is  the  better. 

Recurrent  of  Head  with  the  Double  Roller.  —  Capeline 
bandage  (Fig.  61). 

This  requires  a  double  roller  about  6  yards  long,  one 
roll  being  a  little  larger  than  the  other.  The  center  of 
the  bandage  is  placed  on  the  forehead  and  the  two  cylinders 
are  carried  to  the  occiput,  or  back  of  the  head,  the  smaller 
being  underneath.  The  smaller  one  is  then  reversed  and 


BANDAGES  FOR  THE  FRONT  PART  OF  THE  SCALP        53 

carried  around  the  side  of  the  head,  covering  one-half  of 
the  circular  turn,  the  larger  continuing  its  way  circularly 
around  the  head.  On  arriving  at  the  forehead,  the  smaller 
is  again  crossed  by  the  larger  cylinder  and  a  second  reverse 
is  made,  the  bandage  being  carried  around  the  opposite 
side  of  the  head  (Fig.  61).  The  shorter  roller  is  then 
carried  alternately  from  side  to  side  over  the  scalp  until 
it  is  all  covered  in,  while  the  larger  roller  travels  horizon- 
tally around  it,  binding  in  each  antero-posterior  turn  as 
it  arrives  at  the  occiput  and  forehead.  The  bandage  is 
completed  by  one  or  two  circular  turns  around  the  fore- 
head with  the  longer  roller. 

These  two  recurrent  bandages  of  the  head  are  so  insecure  that,  in  the 
rare  cases  where  it  is  necessary  to  cover  the  entire  scalp  with  a  roller 
bandage,  the  transverse  recurrent,  given  further  on,  is  preferred.  In 
applying  the  recurrent  with  a  single  roller  it  is  sometimes  taught  to 
completely  cover  in  one  side  of  the  scalp  before  proceeding  to  the  other, 
instead  of  making  the  turns  on  alternate  sides  as  advised  above.  It 
will  be  seen  that  in  the  recurrent  with  the  single  roller  the  scalp  is 
covered  from  the  top  toward  the  sides,  while  in  the  double  roller  it 
is  covered  from  the  sides,  to  the  top.  The  capeline  is  one  of  the  oldest 
known  bandages;  it  is  said  to  have  been  found  on  the  most  ancient 
mummies  ever  discovered. 

Bandage  for  the  Front  Part  of  the  Scalp  (Fig.  62). — 
Bandage,  3  yards  X  2  inches. 

When  it  is  desired  to  retain  a  dressing  in  the  neighbor- 
hood of  the  forehead,  the  following  procedure  may  be 
adopted:  The  initial  extremity  is  placed  on  one  temple 
and  fixed  by  one  or  two  circular  turns  (turn  i,  Fig.  62). 
If  the  bandage  is  carried  across  the  forehead  from  the 
patient's  right  to  his  left  side,  on  arriving  behind  the 
left  ear  on  the  second  turn  around,  carry  the  roller  down- 
ward around  the  occiput,  covering  in  at  the  median  line 
one-half  the  circular  turn  (turn  2),  then  go  upward  over 
the  brow,  crossing  the  circular  turn  just  above  the  right 
ear  and  covering  at  the  median  line  half  its  breadth. 


54  BANDAGING 

Then  proceed  obliquely  down  across  the  side  of  the  head 
and  around  the  nape  of  the  neck  (turn  3),  covering  in  one- 
half  of  the  last  turn;  then  up,  crossing  just  above  the  right 
ear,  and  proceed  over  the  front  of  the  head,  overlapping 
one-half  of  the  previous  turn  and  bringing  the  bandage 
down  on  the  left  side  between  the  eye  and  the  ear  (turn  4). 
It  can  either  be  pinned  and  ended  here  or  else  pinned  and 
a  reverse  made  and  finished  by  a  horizontal  circular  turn. 
A  bandage  similar  to  this  is  shown  in  Galen's  work. 


FIG.  62. — BANDAGE  FOR  THE  FRONT    FIG.  63. — TRANSVERSE  RECURRENT 

OF     THE     SCALP.  OF     THE     HEAD. 


The  Transverse  Recurrent  of  the  Head  (Fig.  63).— The 
front  and  back  of  the  head  are  covered  in  by  the  bandage 
just  described  (Fig.  62)  and,  instead  of  ending  at  the  sides 
of  the  head,  the  roller  is  then  passed  backward  and  for- 
ward transversely  over  the  head,  being  pinned  each  time 
above  the  ears.  When  the  scalp  is  entirely  covered  by 
these  transverse  turns,  the  bandage  is  ended  by  one  or 
two  circular  turns  around  the  forehead.  (See  Fig.  63.) 

An  adhesive  strap  placed  in  the  median  line  from  the  forehead  to  the 
occiput  will  render  the  bandage  more  secure.  This  bandage  is  much  to 
be  preferred  to  the  other  recur  rents,  as  it  is  less  liable  to  displacement 
and  is  capable  of  being  more  firmly  applied. 


BANDAGES    FOR   THE    SIDE    OF    THE    HEAD 


55 


Bandage  for  the  Side  of  the  Head  (Fig.  64). — If  it  is  de- 
sired to  retain  a  dressing  on  the  side  of  the  head,  it  can  be 
done  as  follows.  (See  Fig.  64.)  Bandage,  4  yards  X  2 
inches. 

The  extremity  being  fixed  by  one  or  two  circular  turns, 
on  arriving  at  the  forehead  the  bandage  is  inclined  upward 
half  the  width  of  the  circular  turn  and  then  downward 
until  it  is  again  level  with  it  at  the  back.  On  arriving  at 
the  forehead  again,  a  pin  is  inserted  and  a  reverse  made  as 
shown  in  figure  64,  the  bandage  being  carried  still  higher 


FIG.  64. — BANDAGE  FOR  THE  SIDE  OF 
THE  HEAD. 


FIG.  65. — FIGURE  8  OF  THE  HEAD 
AND  JAW. 


on  the  side.  On  arriving  at  the  back  of  the  head  it  is 
again  pinned  and  the  bandage  completed  by  a  reverse 
and  a  circular  turn. 

This  bandage  can  sometimes  also  be  made,  if  the  head 
is  suitably  shaped  and  the  bandage  sufficiently  elastic,  by 
inclining  the  roller  up,  without  any  reverse,  and  carrying 
it  over  the  highest  point  on  the  side  of  the  head.  The 
next  turn  is  made  a  little  lower  down  and  the  third  carried 
directly  around  the  head  above  the  ears,  thus  ending  it. 
This  bandage  has  been  called  the  oblique  of  the  head. 


56  BANDAGING 

Figure  8  of  the  Head  and  Jaw.— Dr.  Chas.  T.  Hunter's 
bandage.  (Fig.  65.)  Bandage,  3  yards  long  X  iM  inches 
wide. 

The  initial  extremity,  being  fixed  by  two  horizontal 
circular  turns  around  the  head,  the  bandage  is  carried 
across  the  nape  of  the  neck  to  the  front  of  the  lower  jaw. 
From  here  it  returns  to  the  back  of  the  neck,  whence  it  again 


FIG.  66. — FIGURE  8  OF  THE  HEAD  AND        FIG.  67. — OCCIPITO-FACIAL  ROLLER. 

NECK. 


makes  a  turn  around  the  head.  Two  or  three  figure  8 
turns  are  thus  made  and  the  bandage  finished  by  a  circu- 
lar turn  around  the  forehead. 

This  bandage,  devised  by  the  late  Dr.  Chas.  T.  Hunter,  may  be 
used  in  affections  of  the  lower  lip  and  jaw  in  which  it  is  not  desired  to 
prevent  opening  of  the  mouth.  It  allows  the  patient  the  use  of  his  jaws. 

Figure  8  of  the  Head  and  Neck  (Fig.  66).— Bandage,  3 
yards  X  2  inches. 

The  initial  extremity  being  fixed  around  the  forehead 
and  occiput,  two  or  three  figure  8  turns  are  made  alter- 
nately around  the  forehead  and  around  the  neck. 

This  bandage  is  of  service  in  retaining  dressings  to  the  back  of  the 
neck.  It  is  an  old  bandage  and  is  described  by  both  Goffre's  and  Thivet. 
Both  this  and  the  preceding  bandages  are  made  more  secure  by  pinning 


BARTON'S  BANDAGE  FOR  FRACTURE  OF  THE  JAW  57 

the  bandage  at  the  back  and  then  carrying  it  forward  over  the  head  and 
pinning  it  to  the  horizontal  turn  on  the  forehead. 

The  Occipito -facial  Roller. — Dr.  D.  Hayes  Agnew's  band- 
age. (Fig.  67.)  Bandage,  4  yards  X  2  or  2^4  inches. 

Place  the  initial  extremity  on  one  temple  and  make 
two  or  three  vertical  turns  over  the  head  and  under  the 
jaw.  These  being  made,  pin  and  reverse  the  bandage 
and  carry  it  around  the  back  of  the  head,  to  be  fastened 
at  the  opposite  temple  as  shown  in  figure  67.  This  band- 
age is  described  by  Professor  Agnew  in  volume  i  of  his 
"Surgery." 

Barton's  Bandage  for  Fracture  of  the  Jaw  (Fig.  68). — 
Bandage,  5  yards  X  2  inches. 

Place  the  initial  extremity  on  the  nape  of  the  neck  just 
beneath  the  occipital  protuberance,  carry  the  roller  up 


FIG.  68. — BARTON'S    BANDAGE. 

between  the  parietal  eminence  and  the  top  of  the  ear, 
keeping  as  near  to  the  ear  as  possible,  thence  obliquely 
over  the  scalp  crossing  the  median  line  in  front  of  the 
highest  point  of  the  skull  and  proceeding  down  along  the 
temple  and  side  of  the  face,  under  the  chin,  up  along  the 
side  of  the  face  and  over  the  skull,  crossing  the  previous 
turn  in  the  median  line.  Then  proceed  obliquely  downward 


58  BANDAGING 

and  backward  between  the  ear  and  parietal  eminence  to  the 
nape  of  the  neck  where  the  bandage  crosses  and  fixes  the  ini- 
tial extremity.  From  here  it  is  carried  forward  around  the 
front  of  the  chin  and  back  again  to  the  nape  of  the  neck, 
whence  it  proceeds  up  over  the  skull  as  before.  Three 
complete  turns  covering  each  other  exactly  are  thus  made, 
completing  the  bandage,  and  pins  inserted  at  the  points 
of  crossing  on  each  side  of  the  chin,  on  top  of  the  head 
and  at  the  nape  of  the  neck.  (See  Fig.  68.) 


This  bandage  was  devised  by  that  "ingenious  surgeon"  Jno.  Rhea 
Barton,  and  is  beyond  question  the  best  of  its  kind.  I  am  not  aware 
that  he  ever  published  a  description  of  it  himself,  the  earliest  printed 
account  that  has  come  under  my  notice  being  by  Sargent  in  his  book  on 
"  Minor  Surgery,"  published  in  Philadelphia  in  1848  and  1856.  He  gave 
the  course,  as  did  also  Prof.  H.  H.  Smith  ("Surgery,"  vol.  i,  p.  116),  as 
going  over  the  center  of  the  parietal  bone  and  the  point  of  junction  of 
the  coronal  and  sagittal  sutures.  It  will  be  found  to  be  less  liable  to 
displacement  if  the  roller  is  carried  as  above  directed,  in  front  of  instead 
of  over  the  parietal  eminences.  This  will  cause  the  point  of  crossing  to 
fall  slightly  in  front  of  the  coronal  suture  and  the  highest  point  of  the 
vault  of  the  skull.  It  will  thus  be  prevented  from  slipping  backward 
or  upward  toward  the  median  line.  Professor  Agnew  ("Surgery," 
vol.  i,  p.  702)  gives  its  course  as  a  little  in  advance  of  the  parietal 
eminences.  Care  should  be  taken  always  to  have  the  point  of  crossing 
on  the  top  of  the  skull  situated  in  the  median  line.  Dr.  Garretson 
("Oral  Surgery")  modifies  this  bandage  by  taking  a  long  strip  of  band- 
age, placing  the  middle  of  it  beneath  the  chin,  and  carrying  the  two 
ends  up  and  crossing  them  on  top  of  the  head,  then  to  the  nape  of  the 
neck,  and  forward  to  the  front  of  the  chin,  where  they  are  fastened. 


Gibson's  Bandage  for  Fracture  of  the  Jaw  (Fig.  69).— 
("Institutes  and  Practice  of  Surgery,"  1824.)  Bandage,  6 
yards  long  X  i%  inches  wide. 

Place  the  initial  extremity  on  the  right  temple  and  carry 
the  roller  directly  over  the  top  of  the  head,  down  in 
front  of  the  left  ear,  under  the  jaw,  and  up  in  front  of  the 
right  ear  to  the  point  of  starting.  Repeat  this  turn  twice. 


THE    TRANSVERSE  BANDAGE    OF    THE    SCALP  $9 

On  arriving  at  the  left  temple  for  the  third  time,  insert  a  pin 
and  reverse  the  bandage,  carrying  it  backward  around 
the  occiput,  along  the  side  of  the  head  just  above  the 
left  ear,  and  around  the  occiput  to  the  point  of  starting 
on  the  right  temple.  Repeat  this  turn  twice.  On  arriv- 
ing above  the  left  ear  for  the  third  time,  incline  the  band- 
age obliquely  downward  and  carry  it  around  the  nape  of 
the  neck.  From  here  it  proceeds  under  the  right  ear  along 
the  right  side  of  the  face,  in  front  of  the  lower  jaw,  under 
the  left  ear,  to  return  to  the  point  of  starting  at  the  nape 
of  the  neck.  Repeat  also  this  turn  twice.  On  the  arrival 


FIG.  69. — GIBSON'S  BANDAGE. 

of  the  bandage  at  the  nape  of  the  neck  for  the  third  time, 
pin  it  and  make  a  reverse  and  carry  the  roller  over  the  top 
of  the  head  in  the  median  line,  to  be  fastened  to  the  turns 
around  the  forehead,  as  shown  in  the  illustration  (Fig. 
69).  Pins  are  to  be  inserted  at  each  point  of  crossing 
of  this  median  with  the  transverse  turns,  and  also  where 
the  vertical  crosses  the  horizontal  ones  at  each  temple 
and  on  each  side  of  the  lower  jaw. 

Sedillot  begins  this  bandage  with  the  horizontal  turns 
around  the  forehead  ("Traite  de  Med.  Op.,"  1865). 

The  Transverse  Bandage  of  the  Scalp. — Author.  (Figs. 
70  and  71.)  When  it  is  desired  to  retain  a  dressing  on 


60  BANDAGING 

the  top  of  -the  head,  as  in  scalp  wounds,  the  following 
bandage  is  advised:  A  roller  2  inches  wide  and  2  yards 
long  is  required.  Place  the  initial  extremity  above  one 
ear  and  carry  the  roller  twice  around  the  head,  inclining 
the  bandage  downward  around  the  occiput,  so  that  its 


FIG.  70.  FIG.  71." 

FIGS.  70  AND  71. — TRANSVERSE  BANDAGE  OF  THE  SCALP. 


FIG.  72. — TWISTED   BANDAGE   OF   THE   SCALP. 

upper  edge  is  level  with  the  occipital  protuberance.  On 
arriving  at  the  starting-point  for  the  second  time,  a  pin 
is  inserted  through  all  of  the  thicknesses  of  the  bandage 
and  the  remaining  portion  carried  over  the  dressing  on 
the  top  of  the  head,  down  beneath  the  bandage  on  the 


THE   KNOTTED  BANDAGE  6 1 

opposite  side,  pulled  firmly  back  up  over  the  dressing 
again,  as  seen  in  figure  70,  to  be  ended  and  pinned  at  the 
point  of  starting.  (See  Fig.  71.) 

The  Twisted  Bandage  of  the  Scalp. — Author.  (Fig.  72.) 
When  a  single  width  of  bandage  is  sufficient  to  retain  the 
dressing,  the  following  may  be  employed:  A  2^-inch 
roller  being  used,  the  initial  extremity  is  placed  above 
the  right  ear  and  the  bandage  fixed  by  being  carried 
around  the  forehead.  On  arriving  above  the  left  ear  for 
the  second  time,  the  bandage  is  twisted  and  carried  around 
the  back  of  the  head  over  the  occipital  protuberance  to 
above  the  right  ear.  Here  it  is  again  twisted  and  fastened 
with  pins.  This  bandage  is  of  service  in  children  with 
protruding  foreheads.  It  can  also  be  used  to  retain  dress- 
ings on  the  scalp  by  passing  over  from  side  to  side  as  in 
the  previous  bandage. 

The  turns  of  these  two  bandages  can  be  multiplied  in  number  and 
shifted  backward  or  forward  according  to  the  position  and  character 
of  the  dressing,  so  as  to  be  applicable  to  various  parts  of  the  scalp. 
The  object  of  inclining  the  bandage  downward  around  the  occiput  is  to 
utilize  the  occipital  protuberance  as  a  means  of  preventing  upward 
displacement.  The  twisting  of  the  transverse  turn  in  the  last  bandage  is 
to  draw  it  in  at  the  sides,  thus  forming  a  sort  of  cup,  which  prevents 
the  dressing  or  bandage  from  becoming  displaced. 

The  Knotted  Bandage  (Fig.  73). — Bandage,  2  to  3  yards 
X  2  inches,  wound  as  a  double  roller. 

The  middle  of  the  bandage  being  placed  on  the  wounded 
part  (Gerdy),  the  two  rolls  are  carried  horizontally  around 
the  head,  crossed  and  brought  back  to  the  point  of  start- 
ing. They  are  here  crossed  and  carried  at  right  angles 
to  their  former  course,  one  going  over  the  head  and  the 
other  around  under  the  jaw,  to  be  fastened  at  the  temporal 
region  (Fig.  73). 

If  desired,  instead  of  ending  the  bandage  at  this  point, 
the  two  rolls  can  be  continued  to  the  opposite  side  and 


62  BANDAGING 

another  knot  made  behind  the  first  one,  the  bandage  being 
ended  around  the  skull.  As  many  knots  as  desired  can 
thus  be  made,  each  being  cast  behind  the  preceding  one. 
This  bandage  is  used  to  confine  dressings  to  the  temporal 
region,  particularly  when  pressure  is  desired. 

By  making  the  knot  farther  down,  the  bandage  can  be 
carried  across  the  eyes.  Making  the  knot  still  lower 
on  the  face  enables  the  bandage  to  be  used  in  confining 


FIG.  73. — THE     KNOTTED     BANDAGE. 

dressings  to  the  upper  or  lower  lip,  or  the  angle  of  the 
mouth.  In  these  bandages,  in  order  to  prevent  the  turns 
from  becoming  displaced,  it  is  well  to  connect  them  with 
a  strip  of  bandage,  going  from  the  nape  of  the  neck  to  the 
forehead  in  the  median  line  and  pinned  to  the  various 
turns. 

BANDAGES  OF  THE  TRUNK 

Spiral  of  the  Chest  (Fig.  74).— Bandage,  8  yards  X  3 
inches. 

Fix  the  bandage  by  two  or  three  circular  turns  around 
ths  chest  high  up  under  the  arms.  Descend  by  slow 
spiral  turns,  covering  one-half  to  two- thirds  of  their  width, 
until  the  waist  is  reached.  Pin  the  bandage  at  the  back 


FIGURE   8   OF   THE   CHEST  63 

and  bring  the  roller  over  the  shoulder  and  down  to  the 
lowest  turn  in  front.  Here  it  is  pinned  and  ended.  A 
pin  is  to  be  inserted  wherever  the  vertical  strip  crosses  the 
horizontal  turns.  (See  Fig.  74.) 

Figure  8  of  the  Chest  (Figs  75  and  76). — Bandage,  two 
rollers,  each  6  yards  X  2%  inches. 

Place  the  initial  extremity  low  down  on  the  front  of  the 
chest.  Carry  the  roller  slightly  downward  and  around 


FIG.  74. — SPIRAL  BANDAGE  OF  THE  CHEST. 

the  chest,  the  point  of  crossing  of  the  lower  border  of  the 
bandage  being  at  or  near  the  median  line.  It  is  then 
carried  again  around  the  chest,  above  the  previous  turn, 
completing  the  first  figure  8.  (See  Fig.  75.)  Another 
turn  is  made  below,  covering  in  the  upper  half  of  the  first 
turn,  followed  by  another  higher  up.  Successive  figure 
8  turns  are  thus  made,  ascending  the  chest  until  the  axillary 
folds  are  reached,  'when  the  bandage  is  completed  by  one 
or  two  circular  turns  (Fig.  76). 

This  bandage  is  similar  to  the  figure  8  bandage  of  the  upper  and  lower 
extremities,  already  described.    The  lower  loop  especially  should  be 


64 


BANDAGING 


FIG.  75. — FIGURE  8  BANDAGE  OF  THE  CHEST,  COMMENCEMENT. 


FIG.  76. — FIGURE    8    BANDAGE   OF   THE    CHEST,    COMPLETED. 


ANTERIOR  FIGURE   8   OF   THE   CHEST  AND   SHOULDERS  65 

carefully  applied.  Each  lower  loop  of  the  figure  8  turns  is  covered  in 
one-half  by  the  succeeding  one,  while  the  upper  loop  is  entirely  covered 
in  by  the  succeeding  lower  ones.  Thus,  when  the  bandage  is  completed, 
the  lower  loops  are  the  only  ones  visible. 

This  is  a  quite  secure  roller  bandage  of  the  chest.  A  possible  objec- 
tion may  be  the  amount  of  bandage  it  consumes. 

Anterior  Figure  8  of  the  Chest  and  Shoulders  (Fig.  77).— 
Bandage,  6  yards  X  2^  inches. 

A  pad  having  been  placed  beneath  each  arm,  if  necessary, 
to  protect  the  axillary  folds  from  pressure,  the  initial  ex- 
tremity is  placed  in  the  axilla  and  fixed  by  a  couple  of  cir- 


FIG.  77. — ANTERIOR  FIGURE  8  BANDAGE  OF  THE  CHEST  AND  SHOULDERS. 


cular  turns  around  the  chest.  The  roller  is  then  carried 
obliquely  upward  across  the  chest,  over  and  down  behind 
the  shoulder,  keeping  well  out  toward  the  point,  and 
through  the  axilla  of  the  same  side.  From  there  it  proceeds 
obliquely  upward  across  the  chest  and  around  the  opposite 
shoulder  to  the  point  of  starting.  This  completes  one 
figure  8  turn.  It  should  be  repeated  twice,  each  turn  cover- 
ing in  two-thirds  of  the  preceding  one  a»d  rising  higher 


66  BANDAGING 

toward  the  neck.     The  turns  are  spread  out  on  the  shoul- 
ders, but  converge  toward  the  axillae,  as  shown  in  figure  77. 

It  is  often  taught  to  commence  this  bandage  by  fixing  the  initial 
extremity  around  the  arm,  but  the  above  method  is  preferable. 

Posterior  Figure  8  of  the  Chest  and  Shoulders. — This  is 
similar  to  the  anterior  figure  8,  described  above,  except 


FIG.  78. — SUSPENSORY  BANDAGE  OF  THE  BREAST. 

that  the  bandage  passes  across  the  back  instead  of  the 
front  of  the  chest.  It  is  sometimes  used  in  injuries  to  the 
clavicle  to  keep  the  shoulders  back,  but  is  more  useful  to 
retain  dressings  after  the  removal  of  tumors,  etc. 


SUSPENSORY   OF  THE  BREAST 


67 


Suspensory  of  the  Breast  (Fig.  78). — Bandage,  6  yards 
X  2j^  inches. 

To  bandage  the  left  breast:  Fix  the  initial  extremity  on 
the  left  side  of  the  chest  by  two  circular  turns,  carrying 
the  bandage  from  left  to  right.  On  arriving  beneath  the 
breast,  incline  the  bandage  upward  and  carry  it  across 
the  lower  portion  of  the  breast  and  over  the  opposite  shoul- 
der. From  there  it  is  brought  down  behind  the  back  and 


FIG.  79. — SUSPENSORY  BANDAGE  OF  BOTH  BREASTS. 

again  under  the  breast,  crossing  the  previous  turn.  Con- 
tinue it  around  the  body  ""and  make  alternate  turns  over 
the  opposite  shoulder  and  around  the  body.  Each  turn 
overlaps  the  preceding  one  one-half  to  two-thirds  of  its 
width.  The  points  of  crossing  should  be  made  in  the 
same  vertical  line  under  the  most  pendent  portion  of  the 
breast.  The  oblique  turns  overlap  each  other  more  as 


68  BANDAGING 

they  pass  over  the  shoulder  than  when  they  cross  under 
the  breast.  (See  Fig.  78.) 

This  bandage  is  sometimes  commenced,  as  advised  by 
Gerby  in  1826,  by  suspending  the  breast  by  a  couple  of 
turns  over  the  opposite  shoulder  and  then  continued 
by  alternate  oblique  and  circular  ones. 

Suspensory  Bandage  of  Both  Breasts  (Fig.  79). — Band- 
age, two  rollers,  each  6  yards  X  2)^  inches. 


FIG.  80. — KIWISCH'S  BANDAGE  FOR  BOTH  BREASTS. 

Place  the  initial  extremity  on  the  right  side  of  the  chest 
and  fix  by  two  circular  turns.  On  arriving  beneath  the 
right  breast,  carry  the  bandage  upward  over  the  opposite 
shoulder,  down  behind  the  back,  and  forward  under  the 
right  breast.  It  is  then  carried  across  the  front  of  the 


VELPEAU'S  BANDAGE   FOR   FRACTURED   CLAVICLE  69 

chest,  covering  in  one-half  the  circular  turn,  under  the 
left  breast,  obliquely  across  the  back  and  over  the  opposite 
shoulder,  to  be  brought  down  in  front  and  under  the  left 
breast.  From  here  it  is  carried  transversely  across  the 
back,  again  across  the  right  breast  and  over  the  opposite 
shoulder.  Passing  down  the  back  and  again  under  the 
right  breast,  it  is  carried  directly  across  the  front  of  the 
chest  and  under  the  left  breast,  to  ascend  the  opposite 
shoulder  as  before.  The  two  breasts  are  thus  covered  alter- 
nately until  the  bandage  is  completed,  each  turn  covering 
one-half  to  two-thirds  the  preceding  one.  (See  Fig.  79.) 

Some  prefer  to  sling  each  breast  by  one  or  two  oblique  turns,  as 
described  under  the  suspensory  of  the  breast,  before  commencing  the 
bandage  proper. 

Kiwisch's  Method  (Fig.  80).— (Roser,  "Chirurgie,"  p. 
252.)  When  it  is  desired  to  firmly  compress  both  breasts, 
the  bandage  of  Kiwisch  is  useful.  After  slinging  both 
breasts  by  a  couple  of  turns  over  the  shoulders,  he  confines 
the  breasts  to  the  body  by  three  or  four  circular  turns, 
finishing  by  two  or  three  figure  8  turns,  as  shown  in  figure 
80.  We  have  used  this  bandage  with  satisfaction  in  cases 
of  chronic  interstitial  mammitis. 

Velpeau's  Bandage  for  Fractured  Clavicle — Modified 
(Fig.  81). — Bandage,  8  yards  X  2^  inches. 

Place  the  arm  in  the  Velpeau  position  by  putting  the 
hand  of  the  affected  side  on  the  opposite  shoulder  and 
bringing  the  elbow  nearly  or  quite  opposite  the  point  of 
the  sternum  in  the  median  line  of  the  body,  thus  pushing 
the  affected  shoulder  upward,  backward,  and  outward. 
Rut  a  pad  over  the  seat  of  fracture.  Place  the  initial 
extremity  of  the  bandage  in  the  axilla  of  the  sound  side 
and  bring  the  body  of  the  bandage  up  behind  the  back, 
well  out  over  the  affected  shoulder  and  down  across  the 
middle  of  the  arm  at  the  insertion  of  the  deltoid  muscle. 
Carry  the  bandage  around  underneath  the  arm  and  across 


7O  BANDAGING 

the  chest  to  the  sound  axilla,  fastening  the  initial  extrem- 
ity. Make  a  second  turn,  covering  the  first  exactly.  On 
arriving  beneath  the  arm  of  the  affected  side  for  the  second 
time,  the  bandage  should  be  directed  horizontally  around 
the  chest.  This  turn  is  carried  transversely  over  the  point 


FIG.  81. — VELPEAU'S  BANDAGE. 

of  the  elbow  and  is  then  directed  upward  beneath  the 
sound  axilla,  across  the  back  and  again  over  the  affected 
shoulder,  covering  in  two-thirds  of  the  preceding  turn. 
From  there  it  goes  down  first  in  front  and  then  beneath 
the  arm,  through  the  sound  axilla  and  again  transversely 
around  the  chest,  covering  in  one-third  of  the  first  trans- 
verse turn.  Alternate  vertical  and  transverse  turns  are 


DESAULT'S  BANDAGE  FOR  FRACTURED  CLAVICLE  71 

made,  the  former  advancing  toward  the  point  of  the  elbow 
and  covering  each  other  two-thirds  of  their  width,  and  the 
latter  rising  on  the  arm  and  chest  and  covering  each  other 
one-third  of  their  width.  When -the  vertical  turns  reach 
the  point  of  the  elbow,  the  bandage  is  completed  by  two 
or  three  successive  circular  turns  around  the  chest,  cover- 
ing the  forearm  of  the  affected  side  nearly  up  to  the  wrist. 
(See  Velpeau,  "  Nouv.  elem.  de  Med.  Oper.,"  Paris,  1839.) 

The  turns  may  be  secured  by  applying  adhesive  straps  or  sewing  them 
together  with  thread.  Velpeau  laid  on  an  additional  bandage  which 
had  been  moistened  with  a  solution  of  dextrin. 

In  commencing  the  bandage,  he  directed  as  follows:  "Le  chef  de 
cette  bande  est  d'abord  appliqu£  sous  Paisselle  du  cote*  sain,  ou  en 
arrieYe  comme  dans  le  cataphraste;"  consequently  it  is  sometimes 
taught  to  begin  it  in  the  axilla  and  sometimes  (Dr.  Hunter,  "Int. 
Ency.  Surgery, "  vol.  i,  p.  494)  over  the  scapula  of  the  sound  side. 
The  former  is  the  more  secure  method. 

Velpeau  also  completed  all  the  vertical  turns  before  making  any 
transverse  ones.  After  making  three  or  four  vertical  turns,  he  began  the 
transverse  ones  at  the  elbow  and  went  up,  finishing  the  bandage  by  one 
or  two  vertical  turns, 

It  is  generally  preferred  here  to  make  the  vertical  and  transverse 
turns  alternate,  until  the  former  reach  the  point  of  the  elbow,  when  they 
cease,  and  the  bandage  is  finished  by  two  or  three  horizontal  circular 
turns.  The  first  vertical  turn  over  the  shoulder  is  the  one  farthest  out, 
the  succeeding  ones  rising  toward  the  neck  and  advancing  inward  on 
the  arm  to  the  point  of  the  elbow. 

When  the  patient  is  very  square-shouldered,  the  vertical  turns  have  a 
tendency  to  mass  themselves  together  in  the  angle  formed  by  the  neck 
and  the  shoulder;  but  when  the  shoulders  are  sloping,  this  tendency 
is  not  seen  and  the  turns  remain  on  the  affected  shoulder  as  one  broad 
band.  In  the  former  case  the  vertical  turns  have  a  fan-shaped  appear- 
ance as  they  descend  from  the  shoulder  and  spread  out  on  the  arm, 
but  in  the  latter  they  are  all  parallel.  This  appearance  is  caused  by 
the  peculiarities  of  the  patient,  and  not  by  any  special  mode  of  applica- 
tion of  the  bandage. 

Desault's   Bandage    for   Fractured    Clavicle — Modified 

(Fig.     82). — Two    rollers,     7    yards     X     2%     inches. 


72  BANDAGING 

A  pad  having  been  placed  in  the  axilla  of  the  affected 
side,  the  arm  is  placed  parallel  with  the  body  and  the  fore- 
arm flexed  at  a  right  angle.  The  initial  extremity  is  placed 
in  the  axilla  of  the  sound  side  and  fixed  by  a  circular 
turn.  The  arm  is  then  bound  to  the  side  by  successive 


FIG.  82. — DESAULT'S  BANDAGE. 


descending  slow  spiral  turns,  covering  each  other  half  their 
width  and  reaching  from  near  the  shoulder  to  the  elbow. 
The  initial  extremity  of  another  roller  is  then  placed 
in  the  sound  axilla  and  the  bandage  carried  behind  the 
chest,  over  the  affected  shoulder,  down  in  front  of  the  arm, 


73 

under  the  elbow,  and  back  again  to  the  sound  axilla.  A 
similar  turn  is  then  made  on  the  front  of  the  chest,  the 
bandage  being  carried  from  the  axilla  across  to  and  over 
the  opposite  shoulder,  down  behind  the  arm,  under  the 
elbow,  and  back  again  to  the  axilla.  In  going  both  behind 
and  in  front  of  the  chest,  the  bandage  always  proceeds  as 
follows,  viz. :  From  axilla  to  shoulder  and  then  to  elbow, 
and  back  to  axilla,  forming  the  letters  A  S  E.  These  turns 
are  repeated  once  or  twice,  each  succeeding  turn  covering  in 
two-thirds  of  the  preceding  one,  and  the  bandage  finished  by 
a  few  circular  turns.  The  hand  is  then  suspended  from  the 
neck  by  a  sling. 

Desault  ("GEuvres  Chirurgicales,"  par  Xav.  Bichat)  used  a  pad 
three  fingers'  breadth  in  thickness,  reaching  from  the  arm  pit  to  the 
elbow.  His  bandage  was  composed  of  three  rollers:  The  first  roller 
was  used  to  retain  the  pad  to  the  side  of  the  chest.  The  second  passed 
circularly  around  the  chest,  from  the  shoulder  to  the  elbow,  confining 
the  arm  to  the  side.  The  third  roller  started  in  the  sound  axilla  and 
made  alternate  loops  in  front  of  and  behind  the  chest,  encircling  the 
arm  of  the  affected  side  and  crossing  in  the  opposite  axilla.  He  made 
the  first  turn  in  front  of  the  chest,  but  as  this  has  a  tendency  to  draw  the 
shoulder  in  and  increase  the  overlapping  of  the  fragments,  it  is  better  to 
make  the  posterior  turn  first,  as  directed  above.  These  axilla-shoulder- 
elbow  turns  did  not  cover  each  other  exactly,  but,  as  he  says,  only 
"en  partie,"  and  the  bandage  ended  by  a  few  horizontal  circular  turns. 
He  suspended  the  hand  by  a  short  broad  bandage,  pinned  to  the  turns 
on  the  front  of  the  chest.  As  this  bandage,  in  its  original  form,  has 
been  found  to  be  too  complicated,  it  is  usually  used  in  the  simplified 
form  given  above. 

Many  other  turns  have  been  described  for  dressing  frac- 
tures of  the  clavicle,  but  they  are  too  numerous  to  mention 
in  detail. 

Thivet  placed  the  hand  in  either  the  Velpeau  or  the 
Desault  position,  and,  having  bound  the  arm  to  the  side 
with  circular  turns,  passed  the  bandage  from  beneath  the 
elbow  of  the  affected  side  over  the  sound  shoulder. 


74  BANDAGING 

Gerdy  ("Traite  des  Bandages,"  1826)  put  the  arm  in 
the  Desault  position  and  brought  his  turns  not  only  over 
the  sound  shoulder  as  did  Thivet,  but  also  from  the  axilla 
of  the  sound  side  over  the  injured  shoulder,  down  behind 
the  arm,  under  the  elbow,  up  again  over  the  injured  shoulder 
to  the  sound  axilla. 


FIG.  83. — BANDAGE  FOR  CONFINING  THE  ARM  TO  THE  SIDE. 

Dr.  Chas.  W.  Dulles  ("Medical  News")  placed  the  hand 
in  a  modified  Velpeau  position  and  then  made  figure  8 
loops,  resembling  those  of  Gerdy,  crossing  on  the  affected 
shoulder,  one  loop  passing  through  the.  sound  axilla  and 
the  other  beneath  the  elbow  of  the  affected  side.  These 
alternated  with  transverse  turns  around  the  chest.  This 
bandage  is  figured  and  commended  favorably  by  A.  Hoffa 
in  his  "Verbandlehre,"  page  34. 


TO   CONFINE   THE   ARM   TO   THE    SIDE 


75 


Hopkins  ("The  Roller  Bandage")  suggested  placing  the 
arm  in  the  Desault  position  and  carrying  the  bandage  from 
the  sound  axilla  over  the  injured  shoulder,  down  behind 
the  arm,  under  the  elbow,  thence  over  the  sound  shoulder, 
across  the  back,  under  the  elbow,  over  the  injured  shoulder, 
and  across  the  back,  to  end  in  the  sound  axilla. 


FIG.  84. — BANDAGE    FOR    FRACTURES    OF    THE    ELBOW. 

To  Confine  the  Arm  to  the  Side.— Author.  (Fig.  83.) 
Fix  the  initial  extremity  by  a  couple  of  turns  around  the 
chest  and  arm  just  above  the  elbow.  Then  bring  the 
roller  under  the  forearm  obliquely  up  over  the  elbow  (turn  i, 
Fig.  82),  across  the  back,  down  over  the  elbow  again  (turn 
2),  around  the  back  and  up  over  the  forearm  (turn  3),  in 
front  of  and  parallel  with  turn  i ;  thence  across  the  back  and 
down  over  the  forearm  near  the  hand  (turn  4),  thence 


76  BANDAGING 

around  the  back  and  across  the  front  of  the  chest  and  arm 
(turns  5  and  6),  there  ending  the  bandage. 

Bandage  for  Fractures  of  the  Elbow. — The  bandage 
shown  in  the  accompanying  figure  (Fig.  84)  is  the  one  which 
is  generally  used  in  fractures  of  the  elbow  exclusive  of  those 
of  the  olecranon  process.  It  is  applied  as  follows :  The  band- 
age is  first  fixed  by  circular  turns  around  the  wrist  and  the 
hand  covered  in  the  usual  manner  (Fig.  29,  p.  27).  When 
the  forearm  has  been  covered  to  just  beyond  the  wrist  the 
bandage  is  to  be  carried  directly  across  and  around  the 
arm,  thus  holding  the  forearm  acutely  bent  on  the  arm. 
Several  transverse  turns  are  taken  around  the  arm  and 
forearm  until  the  point  of  the  elbow  is  reached  when  the 
direction  of  the  bandage  is  turned  and  several  up  and  down 
turns  are  made  over  the  point  of  the  elbow.  The  dressing 
is  completed  by  two  or  three  figure  8  turns  made  around  the 
elbow  and  carried  up  to  the  wrist  whence  it  proceeds 
around  the  neck  and  back  to  the  wrist  so  as  to  hold  the 
hand  well  up  to  the  neck  and  the  elbow  well  flexed.  The 
arm  is  not  to  be  bound  to  the  body. 


PART  II 


THE  TAILED  BANDAGES 

The  tailed  bandages  are  so  called  because  they  consist  of 
a  strip  or  strips  of  material  (gauze  or  muslin),  so  fastened 
together  or  divided  as  to  possess  three  or  more  extremities 
or  tails.  When  these  strips  are  fastened  at  right  angles  to 
one  another  in  the  shape  of  the  letter  T,  they  are  called  T 
bandages. 

When  there  is  only  one  transverse  and  one  upright  part, 
it  is  called  a  single  T  bandage;  but  when  there  are  two 
upright  pieces,  it  is  called  a  double  T  bandage.  When  a 
single  broad  piece  of  bandage  is  torn  from  the  ends  nearly 
to  the  center,  it  sometimes  receives  the  name  of  sling. 

The  ends  are  called  tails  and  the  part  in  the  center  re- 
maining untorn  is  called  the  body. 

In  applying  them,  the  body  is  first  placed  over  the  af- 
fected part  and  then  the  tails  carried  around  the  opposite 
side  and  fastened. 

The  tailed  bandages  can  be  multiplied  indefinitely,  and, 
with  the  exercise  of  a  little  ingenuity,  can  be  applied  to 
all  parts  of  the  body.  Sufficient  examples  are  given  to 
show  the  manner  of  their  construction  and  the  principles 
of  application.  In  many  cases  they  are  to  be  preferred  to 
the  roller  bandage,  particularly  when  the  patient  is  con- 
fined to  bed  or  the  dressings  require  frequent  changes. 
They  are  not,  however,  suitable  for  making  pressure. 

77 


78  BANDAGING 

TAILED  BANDAGES  OF  THE  HEAD 

The  Four-tailed  Bandage  of  the  Head  (Figs.  85,  86,  and 
87). — A  piece  of  material  eight  inches  wide  and  long  enough 
to  go  over  the  scalp  and  tie  under  the  chin  is  torn  from 
each  extremity  to  within  three  or  four  inches  of  the  middle. 


FIG.  85. 


FIG.  86. 


FIG.  87. 
FIGS.  85,   86,   AND  87. — FOUR-TAILED   BANDAGE  OF  THE  HEAD. 


The  body  of  the  bandage  being  placed  on  the  top  of  the 
head,  the  two  posterior  tails  are  tied  under  the  chin  and 
the  two  anterior  ones  around  the  back  of  the  neck  (Fig. 
85).  If  it  is  desired  to  cover  the  back  of  the  head,  as  in 


THE   FOUR-TAILED   SLING   OF   THE   CHIN  79 

figure  86,  the  body  is  placed  farther  back;  the  two  poste- 
rior tails  are  then  fastened  around  the  forehead  and  the  two 
anterior  ones  down  under  the  jaw.  If  it  is  desired  to  cover 
the  front  of  the  head,  the  body  of  the  bandage  is  placed 
at  this  point  and  the  two  anterior  tails  fastened  at  the 
back  of  the  head  and  the  two  posterior  ones  down  under 
the  jaw  (Fig.  87). 

The  Six-tailed  Bandage  of  Galen. — The  "poor  man's 
bandage"  (Fig.  88).  A  piece  of  material  is  taken  long 
enough  to  pass  over  the  head  and  tie  under  the  chin,  and 
wide  enough  to  reach  from  the  root  of  the  nose  in  front  to 
the  nape  of  the  neck  behind.  It  is  then  torn  lengthwise 


FIG.  88. — SIX-TAILED    BANDAGE    OF        FIG.  89. — FOUR-TAILED    SLING    OF 
GALEN.  THE  CHIN. 

so  as  to  form  six  tails,  three  at  each  end,  the  two  middle 
ones  being  broader  than  those  at  the  sides.  In  applying 
it,  the  body  is  placed  on  the  head  and  the  two  broad  tails 
brought  down  and  tied  under  the  chin.  The  two  posterior 
tails  are  then  brought  forward  and  the  two  anterior  tails 
carried  backward  around  the  head  and  fastened. 

This  is  an  excellent  dressing  when  it  is  desired  to  cover 
the  entire  scalp,  and  may  advantageously  replace  the 
recurrent  bandages. 

The  Four-tailed  Sling  of  the  Chin  (Fig.  89).— Place  the 
body  of  the  bandage  on  the  point  of  the  chin.  The  two 


8o  BANDAGING 

upper  tails  are  then  to  be  fastened  around  the  back  of  the 
neck,  while  the  two  lower  ones  are  carried  up  and  tied  on 
the  top  of  the  head.  A  piece  of  bandage  or  two  of  the 
tails  should  connect  the  turn  at  the  back  of  the  neck  with 
that  on  the  top  of  the  head,  as  seen  in  figure  89.  This 
prevents  the  latter  from  slipping  forward  and  thus  becom- 
ing displaced.  Instead  of  fastening  the  lower  tails  at  the 
back  of  the  neck,  they  may  be  crossed  at  this  point  and 
continued  forward  around  the  forehead  and  pinned  there, 
but  this  does  not  make  so  secure  a  bandage  as  the  former 
method. 

The  Four-tailed  Sling  of  the  Neck  (Fig.  90).— Place  the 
body  of  the  bandage  on  the  back  of  the  neck  and  fasten 


FIG.  90. — FOUR-TAILED     SLING     OF        FIG.  91. — DOUBLE  T  BANDAGE  OF 
THE  NECK.  THE  NOSE. 

the  two  upper  tails  around  the  forehead  and  the  two  lower 
ones  around  the  neck,  as  shown  in  figure  90. 

The  Double  T  Bandage  of  the  Nose  (Fig.  91). — A  dress- 
ing having  been  applied  over  the  nose,  the  horizontal 
branch  of  the  bandage  is  carried  around  the  upper  lip  and 
tied  at  the  back  of  the  neck.  The  two  vertical  portions 
are  then  carried  upward,  crossed  at  the  root  of  the  nose, 
and  fastened  to  the  horizontal  turn  at  the  back  of  the  neck. 
(See  Fig.  91.) 


THE   T  BANDAGE   OF   THE   EYE 


8l 


The  T  Bandage  of  the  Ear  (Fig.  92).— The  horizontal 
branch  is  fastened  around  the  head  just  above  the  ears  and 
the  vertical  one  carried  under  the  jaw  to  be  fastened  to 
the  horizontal  branch  on  the  opposite  side.  The  vertical 
branch  may  be  made  wider  at  its  point  of  attachment 
to  the  horizontal  one  if  so  desired,  as  shown  in  figure  93. 
This  will  make  it  more  suitable  for  retaining  dressings  over 


FIG.  92. — T  BANDAGE  OF  THE  EAR. 


FIG.  93.  FIG.  94. 

FIGS.  93  AND  94. — T  BANDAGE  OF  THE  EYE. 

the  ear  or  parotid  region.  If  thought  advisable,  a  slit 
may  be  made  to  allow  the  ear  to  project  through,  thus 
avoiding  pressure  being  made  upon  it. 

The  T  Bandage  of  the  Eye  (Figs.  93  and  94).— A  small 
triangular  piece  sufficiently  large  to  cover  the  eye  is  sewn 


82  BANDAGING 

to  the  horizontal  branch  and  the  vertical  strip  is  attached 
to  its  lower  corner.  The  horizontal  branch  being  fastened 
around  the  head,  the  vertical  one  is  either  carried  around 
under  the  jaw  and  fastened  on  the  opposite  side,  as  shown 
in  figure  92,  or  else  taken  around  to  the  back  of  the  head 
and  fastened  there,  as  shown  in  figure  94. 

THE  TAILED  BANDAGES  OF  THE  TRUNK 

The  Double  T  Bandage  of  the  Chest  (Fig.  95). — A  piece 
of  material  about  eight  inches  wide  and  long  enough  to  go 
one  and  a  half  times  around  the  chest  is  obtained,  and  to 
its  upper  edge,  near  its  middle,  two  strips,  two  inches  wide 


FIG.  95. — DOUBLE  T  BANDAGE  OF  THE  CHEST. 

by  about  fourteen  long,  are  attached.  These  strips  are 
placed  six  to  eight  inches  apart. 

This  bandage  can  be  used  either  to  retain  dressings  on 
the  chest  or  to  support  the  breasts. 

If  used  for  the  former  purpose  the  middle  of  the  bandage 
should  be  placed  on  the  back  and  the  ends  overlapped  and 
secured  in  front.  The  two  vertical  strips  are  then  brought 
over  the  shoulders  and  attached  to  the  bandage  on  the 
front  of  the  chest.  These  prevent  it  from  becoming  dis- 


THE   EIGHT-TAILED  BANDAGE   OF   THE   ABDOMEN  83 

placed  by  slipping  down.  If  it  is  desired  to  support  the 
breasts,  then  the  middle  of  the  bandage  should  be  placed 
on  the  front  of  the  chest  as  shown  in  figure  95,  and  the 
extremities  fastened  on  the  back.  Slits  may  be  cut  for 
the  nipples  and  the  two  vertical  pieces  passed  over  the 
shoulder  and  fastened  on  the  back. 


FIG.  96. — EIGHT-TAILED  BANDAGE  OF  THE  ABDOMEN. 

The  Double  T  Bandage  of  the  Abdomen. — This  is  simi- 
lar to  the  double  T  of  the  chest,  the  ends  being  fastened 
in  front  and  the  two  vertical  strips  passed  from  behind  for- 
ward between  the  thighs  and  fastened  to  the  lower  edge  of 
the  horizontal  part.  The  vertical  strips  are  sometimes 
omitted.  The  bandage  is  then  known  as  the  binder. 

The  Eight -tailed  Bandage  of  the  Abdomen  (Fig.  96).— 
A  piece  of  flannel  is  needed  long  enough  to  go  one  and 


04  BANDAGING 

a  half  times  around  the  body  and  wide  enough  to  reach 
from  the  lower  ribs  to  below  the  top  of  the  thigh-bone. 
Each  end  is  then  divided  for  one-third  the  length  of  the 
bandage  into  four  tails,  leaving  the  middle  third  intact. 
In  applying  it,  the  body  of  the  bandage  is  placed  behind 
and  the  tails  overlapped  alternately  in  front,  from  above 
downward,  in  the  order  shown  in  figure  96,  the  last  tail 
being  secured  by  a  safety  pin  and  additional  ones  being 
inserted  for  security. 

As  this  bandage  has  sometimes  a  tendency,  particularly 
in  fat  people,  and  if  the  tails  are  torn  too  near  to  the  middle 


/ 

FIG.  97. — DOUBLE  T  BANDAGE  OF  THE  PERINEUM. 

of  the  bandage,  to  mass  itself  together  into  a  cord  above 
the  crest  of  the  ilium,  the  plain  binder  or  double  T  band- 
age described  above  is  sometimes  preferred  to  it. 

The  Double  T  Bandage  of  the  Perineum  (Fig.  97).— 
The  horizontal  arm  is  to  be  long  enough  to  allow  of  its 
being  tied  around  the  abdomen  just  above  the  iliac  crests. 
The  vertical  arm  should  reach  from  the  top  of  the  sacrum 
behind  down  under  the  perineum  and  up  to  the  umbilicus 
in  front.  This  part  is  torn  into  two  tails  to  within  six 


THE   T  BANDAGE   OF   THE   GROIN 


or  eight  inches  of  the  opposite  extremity.  It  is  to  be  at- 
tached by  its  undivided  extremity  to  the  middle  of  the 
horizontal  strip.  The  horizontal  arm  having  been  fastened 
around  the  abdomen  just  above  the  iliac  crests,  the  two  ver- 
tical tails  are  brought  under  the  perineum  up  on  either  side 
of  the  genitals  and  fastened  to  the  horizontal  arm  around 
the  abdomen.  This  is  an  effective  and  useful  bandage  in 
retaining  dressings  to  the  perineum,  as  in  cases  of  fistulae, 
etc. 

If  it  is  desired  to  use  this  bandage  after  operations  on 
the  scrotum  or  neighboring  tissues,   the  vertical  branch 


FIG.  98. — T  BANDAGE  OF  THE 
GROIN. 


FIG.  99. — T  BANDAGE  OF  THE 
BUTTOCK. 


should  be  increased  in  width  to  six  or  eight  inches,  and 
enough  left  undivided  to  reach  from  the  horizontal  branch 
above  to  the  perineal  center  below.  The  body  of  the  band- 
age is  placed  in  front,  and  the  two  ends  of  the  horizontal 
branch  fastened  behind.  The  vertical  one  is  then  carried 
down,  passed  between  the  thighs,  and  the  two  ends  fas- 
tened to  the  horizontal  branch  behind  or  at  the  sides.  An 
opening  is  made  in  front  for  the  penis. 

The  T  Bandage  of  the  Groin  (Fig.  98). — The  horizontal 
arm  should  be  long  enough  to  fasten  conveniently  around 


86  BANDAGING 

the  abdomen.  To  this  is  sewn,  by  its  base,  a  triangle  ten 
inches  long  and  eight  inches  broad.  To  the  apex,  a  strip 
long  enough  to  go  around  the  thigh  is  attached.  The  hori- 
zontal arm  being  fastened  around  the  abdomen  just  above 
the  iliac  crests,  the  vertical  arm  is  passed  between  the 
thighs,  carried  around  the  outside,  and  fastened  in  front, 
as  shown  in  figure  98. 

The  T  Bandage  of  the  Buttock  (Fig.  99). — This  is  similar 
to  that  of  the  groin,  except  that  the  triangular  portion  is 
made  slightly  larger  and  is  applied  over  the  buttock  instead 
of  the  groin.  It  is  shown  in  figure  99. 

These  two  bandages  are  sometimes  very  useful,  as  they 
can  be  made  quite  secure  and  permit  of  ready  access  to 
the  parts  beneath,  more  so  than  the  roller  bandages. 


THE  TAILED  BANDAGES  OF  THE  EXTREMITIES 

The  Four-tailed  Sling  of  the  Shoulder  (Fig.  100). — A 
square  piece  of  material  large  enough  to  cover  the  shoulder 
should  have  attached  to  its  corners  two  long  and  two  short 
tails.  The  body  of  the  bandage  being  applied  over  the 
shoulder,  the  two  short  tails  are  tied  around  the  arm  and 
the  two  long  tails  in  the  opposite  axilla,  as  shown  in  figure 
100.  By  untying  the  upper  tails  and  turning  down  the 
bandage,  the  dressing  beneath  is  easily  accessible. 

The  Four-tailed  Sling  of  the  Axilla  (Fig.  100). — A  square 
or  rectangular  piece  of  muslin,  large  enough  to  contain 
the  application,  has  attached  to  its  corners  four  tails.  The 
body  of  the  bandage  being  placed  in  the  axilla,  the  two 
lower  tails  are  tied  around  the  chest  and  the  two  upper 
ones  crossed  on  the  shoulder  of  the  same  side  and  fastened 
in  the  opposite  axilla.  (See  Fig.  100.) 

The  Four -tailed  Sling  of  the  Arm  (Fig.  101). — A  piece  of 
muslin  ten  or  twelve  inches  wide  and  nearly  two  yards  long 
is  torn  from  each  end  to  within  four  inches  of  its  middle. 


THE   PERFORATED   T  BANDAGE    OF    THE    HAND  87 

A  slit  is  made  in  the  center  to  receive  the  point  of  the  elbow. 
The  body  of  the  bandage  being  placed  beneath  the  elbow, 
the  two  lower  tails  are  fastened  over  the  opposite  shoulder, 
preferably  by  safety  pins,  and  the  two  upper  tails  fastened 
around  the  chest.  (See  Fig.  101.) 

The  Perforated  T  Bandage  of  the  Hand  (Figs.  102  and 
103). — A  piece  of  muslin  is  needed  as  wide  as  the  palm  of 
the  hand  and  long  enough  to  reach  from  the  wrist  to  the 


FIG.  100. — FOUR-TAILED  SLINGS  OF  THE  SHOULDER  AND  OF  THE  AXILLA. 


web  of  the  fingers  and  back  again  to  the  wrist.  Trans- 
versely across  the  middle  of  this  piece,  four  holes  are  made 
for  the  insertion  of  the  fingers.  At  the  corners  of  one  end 
two  strips  are  attached  long  enough  to  allow  of  their  being 
secured  around  the  wrist.  The  prepared  bandage  is  shown 
in  figure  102.  It  is  used  to  retain  applications  to  the  back 
or  palm  of  the  hand.  If  desired  to  apply  to  the  dor  sum, 
the  fingers  are  thrust  through  the  holes  and  the  two  tails 
fastened  around  the  wrist  as  seen  in  figure  103 ;  the  re- 
maining portion  is  then  brought  up  and  pinned  to  the  strips 
around  the  wrist. 


BANDAGING 


If  used  to  retain  a  dressing  to  the  palm,  then  the  part 
of  the  bandage  with  the  tails  attached  is  placed  on  the 
back  of  the  hand  and  the  loose  portion  brought  over  the 


FIG.  101. — FOUR-TAILED  SLING  OF  THE  ARM. 


FIG.  102.  FIG.  103. 

FIGS.    1 02  AND   103. — PERFORATED   T  BANDAGE  OF  THE  HAND. 

dressing  on  the  palm  and  fastened  at  the  wrist.  If  so 
preferred,  this  part  of  the  bandage  may  be  made  long 
enough  to  allow  of  its  being  secured  by  the  tails  around 
the  wrist  instead  of  pinning. 


THE   MANY-TAILED  BANDAGE    OF    SCULTETUS 


89 


The  Four-tailed  Sling  of  the  Knee  (Fig.  104). — A  square 
piece  of  muslin  large  enough  to  cover  the  knee  or  the  popli- 
teal space  has  attached  to  its  corners  four  tails.  In  apply- 
ing it,  the  body  of  the  bandage  is  placed  over  or  under  the 
knee  as  desired,  and  the  two  upper  tails  fastened  around 
the  thigh  and  the  two  lower  ones  around  the  leg  just  below 
the  patella.  (See  Fig.  104.) 

The  Many-tailed  Bandage  of  Scultetus  (Fig.  105). — A 
number  of  strips  of  bandage  are  made  two  or  more  inches 


FIG. 


104. — FOUR-TAILED    SLING 
OF  THE  KNEE. 


FIG.  105. — MANY-TAILED    BANDAGE 
OF  SCULTETUS. 


in  width  and  long  enough  to  reach  one  and  a  half  times 
around  the  leg.  On  account  of  its  circumference  increasing 
from  the  ankle  upward,  the  strips  should  be  made  pro- 
portionally longer  as  the  limb  is  ascended.  The  number 
of  strips  to  be  employed  varies  according  to  therr  width 
and  the  extent  of  the  limb  to  be  covered.  If  narrow 
strips  are  used  and  the  whole  leg  is  to  be  enveloped,  twelve 


QO  BANDAGING 

may  be  required ;  but  if  the  width  of  the  strips  is  increased 
to  three  or  four  inches  and  the  leg  is  only  to  be  partially 
covered,  three,  four,  or  five  may  be  sufficient. 

The  size  and  number  of  the  strips  having  been  decided 
on,  they  are  laid  transversely  on  a  towel,  or  pillow,  or 
board,  the  top  strip  being  laid  first  and  each  successive 
one  covering  the  preceding  piece  one- third  of  its  width. 
The  limb  is  then  raised  from  the  bed,  and  the  cloth  or 
pillow  on  which  the  strips  are  lying  is  slid  beneath  it. 
(See  Fig.  105.)  Another  method  is  to  roll  the  bandage 
from  each  side  toward  the  center,  and  then  grasping  a  roll 
in  each  hand,  to  place  it  beneath  the  limb.  If  so  desired, 
the  strips  on  each  side  of  the  leg  may  be  moistened  with  a 
sponge  dipped  in  an  evaporating  lotion.  Beginning  with 
the  lowest,  the  two  ends  of  each  strip  are  then  brought 
forward  and  crossed  on  the  front  of  the  leg  (see  the  figure), 
the  last  being  fastened  by  pinning,  or,  as  preferred  by  Dr. 
Geo.  W.  Norris,  tied. 

This  bandage  allows  the  parts  to  be  inspected  without  moving  the 
limb.  If  any  of  the  strips  become  soiled  they  can  be  readily  replaced 
with  clean  ones  by  pinning  the  clean  to  the  soiled  strips  and  then  pulling 
them  through.  Percival  Pott  attached  the  strips  together  by  sewing 
them  down  the  middle.  This  necessitates  the  removal  of  the  whole 
bandage  if  it  is  desired  to  replace  a  soiled  strip.  This  bandage  forms  a 
good  means  of  retaining  dressings  in  injuries  of  the  leg  when  the  frac- 
ture box  is  used,  as  its  adjustment  involves  no  disturbance  of  the 
member. 


PART 


THE  HANDKERCHIEF  BANDAGES 

The  handkerchief  bandages  are  those  made  of  handker- 
chiefs or  other  material  in  the  form  of  a  square.  They  have 
been  in  use  for  centuries,  but  in  1832,  Mayor,  a  surgeon  of 
Lausanne,  Switzerland,  published  a  work  entitled  "Un  nou- 
veau  systeme  de  deligation  chirurgicale."  In  this  work  he 
added  many  new  bandages  to  those  already  existing,  classi- 
fied and  named  them,  and  advocated  their  use  for  all  parts 
of  the  body.  He  enlarged  and  systematized  the  subject  so 
well  that  he  has  been  regarded  as  the  originator  of  a  new 
system  of  surgical  dressings,  and  it  is  spoken  of  as  Mayor's 
system  of  handkerchief  dressings. 

In  many  cases  these  dressings  are  far  superior  to  the  roller 
bandages,  particularly  where  support  rather  than  pressure  is 
desired,  as  in  the  handkerchiefs  for  the  arm.  Sometimes 
they  can  be  well  applied  to  places  that  it  is  very  difficult  to 
cover  satisfactorily  with  a  roller  bandage,  as  the  gluteal 
region. 

When  an  application  has  been  made  to  a  part  that  re- 
quires frequent  attention,  the  handkerchief  bandage  allows 
ready  access  to  it;  thus,  in  contusions  of  the  shoulder  in 
which  it  is  desired  to  apply  an  evaporating  lotion,  the  tri- 
angular cap  retains  the  dressing  well,  and  at  the  same  time, 
by  freeing  and  turning  down  the  point  of  the  triangle  the 
dressing  can  at  once  be  inspected. 

91 


Q2  BANDAGING 

They  are  also  useful  as  provisional  dressings  in  war  and 
cases  of  accident.  The  roller  bandage  is  sometimes  im- 
possible to  obtain,  while  the  handkerchief  is  found  every- 
where, and  a  person  possessing  some  knowledge  of  the  sub- 
ject can,  with  the  exercise  of  a  little  ingenuity,  adapt  them 
to  almost  any  form  of  injury. 


PIG.  1 06. — RECTANGLE  OR  OBLONG. 


FIG.  107. — TRIANGLE. 

Materials. — Handkerchief  bandages  are  made  with  cot- 
ton, linen,  or  silk  squares,  of  various  sizes,  according  to  the 
parts  to  be  covered. 

The  material  used  should  be  thin  and  pliable.  If  un- 
bleached muslin  is  employed,  it  should  be  the  thinnest  ob- 
tainable. Cheese-cloth  often  makes  an  excellent  handker- 
chief, particularly  when  a  large  one  is  desired.  Large  linen 
or  silk  handkerchiefs  are  also  good.  The  handkerchief  is 


MATERIALS   USED  FOR  HANDKERCHIEF  BANDAGES 


93 


rarely  employed  in  the  form  of  a  square,  but  is  folded  into 
various  shapes,  according  to  the  use  to  which  it  is  to  be  put. 

When  folded  across  its  middle  from  side  to  side,  it  forms  a 
rectangle  or  oblong,  as  seen  in  figure  106. 

When  folded  diagonally  across  from  corner  to  corner,  as 
seen  in  figure  107,  it  forms  the  triangle. 

The  longest  side  of  the  triangle  is  its  base. 


FIG.  108. — CRAVAT. 


FIG.  109. — REEF  KNOT. 


FIG.  no. — GRANNY  KNOT. 


The  angles  at  each  end  of  the  base  are  called  the  extremi- 
ties or  ends  of  the  triangle,  and  the  angle  opposite  to  the  base 
is  called  its  apex  or  point. 

When  a  triangle  is  loosely  rolled  together  or  folded  from 
side  to  side  repeatedly,  the  apex  being  laid  toward  the  base, 
it  forms  the  cravat.  (See  Fig.  108.) 

A  twisted  cravat  is  called  a  cord.     It  is  rarely  used. 

In  naming  the  handkerchief  bandages,  the  first  portion  of 
the  name  was  intended  to  designate  the  part  of  the  body  to 
which  the  base  of  the  handkerchief  was  to  be  applied,  but 
this  has  not  been  carried  out  in  all  cases.  The  ends  of  a 
handkerchief  may  be  fastened  either  by  pinning  or  knotting. 


94  BANDAGING 

If  pinned,  a  safety  pin  is  the  best  to  use.  If  knotted,  a  reef 
knot,  as  shown  in  figure  109,  is  the  one  to  be  employed,  and 
not  the  Granny  knot,  as  shown  in  figure  no;  the  latter  is 
insecure  and  liable  to  slip.  To  avoid  discomfort  it  should, 


FIG.  in. — CLOVE  HITCH. 

when  possible,  not  be  made  on  a  prominent  bony  part,  and 
the  parts  beneath  should  be  guarded  by  a  wad  of  cotton. 
The  clove  hitch  shown  in  figure  in,  is  useful  in  making 
traction,  as  in  dislocations. 

THE    SPECIAL    HANDKERCHIEF    BANDAGES 

BEGINNING   AT   THE   HEAD   AND   PROCEEDING   DOWNWARD 

i.  HANDKERCHIEF  BANDAGES   FOR  THE   HEAD 

The  Occipito -frontal  Triangle  (Fig.  112). — Place  the  base 
of  the  triangle  on  the  nape  of  the  neck  and  bring  the  apex 
forward  over  the  head,  allowing  it  to  hang  down  in  front. 
Knot  the  extremities  around  the  forehead,  as  seen  in  figure 
112,  and  turn  the  apex  up  and  pin  it. 

The  Fr  onto -occipital  Triangle  (Fig.  113). — Place  the  base 
on  the  forehead  and  allow  the  apex  to  hang  down  the  back 
of  the  neck.  Tie  the  extremities  just  below  the  occipital 
protuberance  and  bring  the  apex  up  and  pin  it,  as  seen  in 
figure  113. 

On  account  of  the  knot  being  behind,  it  is  apt  to  cause  some  incon- 
venience if  the  bandage  is  worn  in  bed.  Under  these  circumstances 
the  former  bandage  is  more  suitable. 


THE  VERTIGO-MENTAL    TRIANGLE 


95 


The  Bi-temporal  Triangle  (Fig.  114). — Place  the  base  of 
the  triangle  on  the  side  of  the  head  just  above  one  ear 
and  allow  the  apex  to  hang  down  over  the  other  ear.  Carry 
the  extremities  around  and  knot  them  over  the  apex  of  the 


FlG.    112. OCCIPITO-FRONTAL    TRI- 
ANGLE. 


FIG.    113. — FRONTO-OCCIPITAL  TRI- 
ANGLE. 


FIG.  114. — BI-TEMPORAL  TRIANGLE. 


FIG.  115. — VERTIGO-MENTAL   TRI- 
ANGLE. 


triangle  on  the  opposite  side  of  the  head.     The  apex  should 
then  be  turned  up  and  pinned,  as  shown  in  figure  114. 

The  Vertico-mental  Triangle  (Fig.  115).— Place  the  base 
of  the  triangle  on  the  top  of  the  head,  the  apex  being  back- 
ward, and  knot  the  two  extremities  under  the  chin.  The 
apex  is  then  brought  around  to  one  side  and  pinned.  (See 
Fig.  115. 


96  BANDAGING 

The  Auriculo-occipital  Triangle  (Fig.  116). — Place  the 
base  of  the  triangle  on  the  side  of  the  face  in  front  of  the  ear, 
the  apex  pointing  backward.  Carry  the  extremities  to  the 
opposite  side  and  fasten  them  by  pinning.  Fold  the  apex 
around  the  back  of  the  head  and  pin  it  to  the  extremities  in 
front  of  the  ear,  as  seen  in  figure  116. 

The  Fronto-occipito-labialis  Cravat  (Fig.  117). — Place 
the  body  of  the  cravat  on  the  forehead  and  carry  the  ex- 
tremities around  the  back  of  the  head,  to  be  brought  forward 
and  crossed  on  the  upper  lip,  where  they  are  to  be  pinned  as 
seen  in  figure  117. 


FIG.  116. — AURICULO-OCCIPITAL  TRI-  FIG.  117. — FRONTO-OCCIPITO-LABI- 

ANGLE.  ALIS  CRAVAT. 


It  may  be  used  to  retain  dressings  to  the  upper  lip.  Mayor  also  made 
a  triangle  of  the  same  name,  using  the  handkerchief  folded  in  the  form 
of  a  triangle  instead  of  a  cravat. 

The  Square  Cap  of  the  Head  (Figs  118  and  119). — A 
handkerchief  should  be  used  possessing  a  side  long  enough  to 
go  over  the  top  of  the  head  and  allow  its  corners  to  be  easily 
tied  under  the  chin.  It  is  then  folded  across  its  middle  and 
one  side  brought  to  within  an  inch  or  two  of  the  opposite 
one.  Place  it  transversely  on  the  head,  the  folded  edge 
being  behind  and  the  middle  of  the  handkerchief  being  in 
the  median  line.  The  longer  of  the  two  sides  should  be 


THE  SQUARE  CAP  OF  THE  HEAD  97 

next  the  scalp  and  the  edge  of  the  shorter  side  passing 
across  the  forehead.  The  four  corners  are  allowed  to  hang 
down  on  the  shoulders,  two  on  each  side.  This  arrange- 
ment is  seen  in  figure  1 18.  The  two  outer  corners  are  then 
grasped  and  tied  under  the  chin.  The  two  inner  corners 
are  to  be  pulled  out  until  the  posterior  edge  and  sides  of 
the  handkerchief  lie  as  neatly  and  closely  around  the  back 
of  the  neck  as  possible.  This  having  been  done,  the  edge 
which  projects  over  the  forehead  is  folded  backward  and 


FIG.  118.  FIG.  119. 

FIGS.  118  AND  119. — THE  SQUARE  CAP  OF  THE  HEAD. 


the  ends  are  twisted  and  tied  or  pinned  together  at  the 
back  of  the  neck  and  all  the  folds  neatly  adjusted.  The 
completed  dressing  is  shown  in  figure  119. 

This  dressing  was  used  by  the  ancient  surgeons  in  cases  of  trephining, 
but  it  is  now  displaced  by  less  cumbersome  ones.  It  is  commonly  made 
with  a  much  larger  handkerchief  than  the  one  here  advised,  the  under 
nortion  of  the  bandage  being  allowed  to  hang  down  to  the  end  of  the 
pose  and  the  upper  to  the  eyebrows.  When  made  in  this  manner,  the 
portion  of  the  handkerchief  remaining  projecting  at  the  sides  of  the  neck 
was  turned  up  and  pinned  on  either  side  of  the  head. 

The  two  ends  which  are  fastened  around  the  back  of  the  neck  are 
called,  from  their  spreading  form,  "goose  feet." 

7 


98  BANDAGING 

The  Triangular  or  Hunter's  Cap  of  the  Head  (Figs.  120 
and  121). — This  requires  a  handkerchief  with  a  side  long 
enough  to  pass  over  the  head  and  fasten  under  the  chin.  It 
is  first  folded  transversely  across  the  middle  until  one  side  is 
within  an  inch  of  the  opposite  one.  It  is  then  turned  over, 
the  shorter  side  being  placed  underneath.  Turn  the  two 
corners  of  the  folded  edge  inward,  forming  a  triangle,  as  seen 
in  figure  120.  The  two  extremities  of  this  triangle  should 
be  taken  in  either  hand,  and  while  kept  tense,  twisted  and 
rolled  up  to  the  extent  of  almost  two  inches.  On  lifting 


FIG.  120.  FIG.  121. 

FIGS.  120    AND    121. — THE    TRIANGULAR    CAP    OF    THE    HEAD. 


the  handkerchief,  the  hands  should  be  approached  slightly 
to  each  other,  thus  causing  the  two  sides  to  separate.  It 
is  then  turned  around  and  placed  on  the  head,  the  thin 
edge  coming  down  over  the  forehead  and  the  rolled  or 
thick  edge  going  down  around  the  back  of  the  neck.  Tie 
the  two  ends  together  under  the  chin  and  the  bandage  is 
completed,  as  seen  in  figure  121. 

This  bandage  is  said  to  be  used  by  the  hunters  in  the  Adirondack 
Mountains  to  protect  themselves  from  the  bites  of  insects.  It  requires 
less  material  than  the  square  cap  of  the  head  and  is  less  heating. 


THE   PARIETO-AXILLARIS   TRIANGLE 


99 


2. 


HANDKERCHIEFS  FOR  THE  HEAD  AND  TRUNK 


The  Occipito-sternal  Triangle  (Fig.  122). — A  cravat  is 
first  to  be  fastened  around  the  body  just  below  the  arms. 
The  body  of  a  triangle  is  then  placed  on  the  back  of  the  head 
and  the  two  extremities  brought  forward  and  fastened  to  the 


FIG.  122. — OCCIPITO-STERNAL  TRIANGLE. 


cravat  around  the  body.  The  apex  is  then  to  be  brought 
around  to  one  side  of  the  head  and  pinned,  as  seen  in 
figure  122. 

It  is  designed  to  keep  the  head  flexed  on  the  body  in  cases  of  wounds 
of  the  neck,  as  cut  throat,  etc. 


The  Parieto-axillaris  Triangle  (Fig.  123). — If  it  is  desired 
to  incline  the  head  to  one  side  instead  of  forward,  then  the 
cravat  should  be  placed  around  one  shoulder  and  the  body 
of  the  triangle  over  the  parietal  region  of  the  opposite  side  of 


100 


BANDAGING 


FIG.  123. — PARIETO-AXILLARIS  TRIANGLE. 


FlG.    124. DORSO-BIS- AXILLARY     TRIANGLE     OR     BREAKFAST     SHAWL. 


THE   SIMPLE   FIGURE   8   CRAVA7   QtfVllE   £HOULl}ER  IOI 


the  head.  The  extremities  are'  then  fastened  $$;tHe  cravat 
around  the  shoulder  and  the  head  drawn  over  as  seen  in 
figure  123. 

3.  HANDKERCHIEFS  FOR  THE  CHEST 

The  Dorso  -bis  -axillary  Triangle.  —  (The  Breakfast  Shawl, 
or  Cermco-dor  so-sternal  Triangle  of  Mayor,  Fig.  124.)  Fasten 
a  cravat  around  the  body  beneath  the  arms.  The  base  of 


FlG.    125. BlS- AXILLARY  CRAVAT. 


a  large  triangle  is  then  placed  on  the  nape  of  the  neck,  the 
two  extremities  being  brought  down  in  front  of  the  chest 
and  fastened  to  the  cravat  around  the  body.  The  apex  of 
the  triangle  is  passed  under  the  cravat  on  the  back  and 
pinned.  (See  Fig.  124.) 

It  is  intended  to  retain  applications  to  the  back. 

» 

The  Simple  Figure  8  Cravat  of  the  Shoulder,  or  the  Sim- 
ple Bis-axillary  Cravat  (Fig.  125). — The  body  of  the  cravat 


102 


BANDAGING 


being  placed  in  one  axilla,  the  ends  are  crossed  over  the 
shoulder  and  tied  in  the  opposite  axilla.     (See  Fig.  125.) 

The  Compound  Figure  8  Cravat  of  the  Shoulder,  or  the 
Compound  Bis-axillary  Cravat  (Fig.  126). — The  body  of  a 
small  cravat  is  placed  in  one  axilla  and  the  ends  tied  over 
the  shoulder.  The  body  of  a  larger  cravat  is  then  placed  in 
the  opposite  axilla  and  its  extremities  carried  across,  one  in 
front  of  and  the  other  behind  the  chest.  The  posterior  ex- 


FIG.  126. — COMPOUND    Bis- AXILLARY    CRAVAT. 


tremity  should  be  passed  through  the  loop  on  the  top  of  the 
shoulder  formed  by  the  small  cravat  and  fastened  to  the 
anterior  one  in  front  of  the  chest,  as  seen  in  figure  126. 

Both  of  these  cravats  are  well  adapted  to  retain  dressings  in  the  axilla. 

The  Simple  Figure  8  Cravat  of  the  Back,  or  the  Simple 
Dorso -bis -axillary  Cravat. — Mayor.  (Fig.  127.)  Some- 
times called  the  bis-axilla-scapulary  cravat.  The  body  of  a 
long  cravat  is  placed  obliquely  across  the  back,  one  extrem- 
ity being  carried  around  one  shoulder  from  above  downward 


THE   COMPOUND  FIGURE   8   CRAVAT  OF  THE  BACK 


103 


and  the  other  around  the  opposite  shoulder  from  below  up- 
ward. The  two  ends  are  then  brought  across  the  back  and 
fastened.  (See  Fig.  127.) 


PlG.    127. DORSO-BIS- AXILLARY    CRAVAT. 


FIG.  128. — COMPOUND  DORSO-BIS- AXILLARY  CRAVAT. 

The  Compound  Figure  8  Cravat  of  the  Back,  or  the  Com- 
pound Dorso-bis-axillary  Cravat. — Mayor.  (Fig.  128.)  A 
short  cravat  is  tied  around  one  shoulder.  A  long  cravat  is 


104 


BANDAGING 


then  passed  around  the  opposite  shoulder  and  tied  in  a  single 
knot  on  the  back.  Pass  one  of  the  ends  under  the  short 
cravat  and  fasten  the  two  extremities,  as  seen  in  figure  128. 

If  it  is  desired  to  draw  the  shoulders  back,  as  sometimes  occurs  in 
injuries  of  the  clavicle,  it  can  be  well  done  with  this  bandage,  as  con- 
siderable force  can  be  exerted  by  drawing  on  the  two  extremities  of 
the  longer  cravat,  previous  to  fastening. 

The  Thoracico -dorsal  Triangle. — (The  Thoracico-scapu- 
lary  Triangle  of  Mayor,  Fig.  129.)  The  base  of  a  large  tri- 


FIG.  129. — THORACICO-DORSAL  TRIANGLE. 


angle  is  placed  on  the  front  of  the  chest  and  the  two  extremi- 
ties passed  around  under  the  arms  and  tied  on  the  back. 
The  apex  is  then  carried  over  one  of  the  shoulders  and  fas- 
tened to  the  part  on  the  back.  If  the  apex  is  not  long 
enough  to  allow  of  its  being  fastened,  it  should  be  length- 
ened by  attaching  to  it  a  cravat  or  piece  of  bandage  (Fig. 
129). 

It  is  of  service  in  retaining  dressings,  on  the  front  of  the  chest  and 
mammary  region. 


TRIANGULAR  CAP   OR   SUSPENSORY   OF   THE  BREAST  10$ 


FIG.  130. — THORACICO-LATERAL  TRIANGLE. 


FIG.  131. — TRIANGULAR  CAP  OR  SUSPENSORY  OF  THE  BREAST. 


106  BANDAGING 

The  Thoracico -lateral  Triangle  (Fig.  130). — This  band- 
age is  intended  for  use  in  case  of  disarticulation  at  shoulder- 
joint.  The  base  of  the  triangle  is  placed  on  the  affected  side 
of  the  chest,  and  the  extremities  fastened  under  the  opposite 
arm.  The  apex  should  then  be  carried  up  and  folded 
over  the  affected  shoulder,  being  pinned  in  front,  as  seen  in 
figure  130. 

The  Triangular  Cap,  or  Suspensory  of  the  Breast  (Fig. 
131). — The  base  of  a  large  triangle  is  placed  under  the 
affected  breast,  one  end  being  carried  beneath  the  axilla 
and  the  other  around  the  opposite  side  of  the  neck,  to  be 
tied  together  on  the  back.  The  apex  should  then  be 
brought  up  and  passed  over  the  shoulder  of  the  affected 
side  and  fastened  to  the  bandage  behind.  (See  Fig.  131.) 


This  is  a  convenient  mode  of  slinging  the  breast  in  nursing  women 
or  other  cases  where  simple  support  is  desired.  It  is  not  suitable  when 
pressure  is  wanted,  the  roller  bandage  being  preferable  in  such  cases. 


4.  HANDKERCHIEFS  FOR  SLINGING  THE  ARM 

The  Brachio -cervical  Cravat  (Fig.  132). — The  forearm 
being  flexed,  the  body  of  a  cravat  is  placed  beneath  the 
wrist  and  its  two  ends  carried  around  the  neck  and  fastened 
in  front  and  to  one  side,  as  seen  in  figure  132. 

The  knot  should  never  be  placed  on  the  back  of  the  neck, 
and  if  the  pressure  at  this  point  is  too  great,  cotton  or  other 
material  should  be  placed  beneath  the  handkerchief  to  pre- 
vent the  cravat  irritating  the  neck. 

The  Compound  Brachio-cervical  Cravat. — The  arm  can 
also  be  supported  by  two  cravats,  a  short  one  tied  loosely 
around  the  neck,  through  which  is  tied  the  ends  of  the  one 
supporting  the  arm.  (See  Fig.  133.) 


COMPOUND  BRACHIO-CERVICAL  CRAVAT 


107 


FIG.  132. — BRACHIO-CERVICAL  CRAVAT. 


FIG.  133. — COMPOUND  BRACHIO-CERVICAL   CRAVAT. 


108  BANDAGING 

The  Simple  Brachio -cervical  Triangle  (Fig.  134). — The 
forearm  being  flexed  at  a  right  angle,  the  base  of  a  triangle  is 
placed  under  the  wrist  and  the  two  extremities  tied  around 
the  neck,  the  knot  being  thrown  to  one  side.  The  apex 
should  then  be  brought  around  the  elbow  and  pinned  in 
front,  as  seen  in  figure  134. 

In  using  this  handkerchief  for  fractured  clavicle,  an  addi- 
tional cravat  may  be  passed  around  the  body,  just  above 
the  forearm,  thus  confining  the  arm  to  the  side. 


FIG.  134. — BRACHIO-CERVICAL  TRIANGLE. 

The  Compound  Brachio -cervical  Triangle  (Fig.  135). — A 
short  cravat  is  tied  loosely  around  the  neck,  the  knot  being 
placed  in  front.  Place  the  base  of  the  triangle  under  the 
wrist,  the  apex  projecting  beyond  the  point  of  the  elbow. 
Bring  the  two  extremities  up  and  fasten  them  to  the  cravat 
around  the  neck.  The  apex  should  then  be  neatly  folded 
around  the  elbow  and  pinned  in  front,  as  seen  in  figure  135. 

The  broad  body  of  the  cravat  around  the  neck  enables  the 
patient  to  bear  the  pressure  of  the  weight  of  the  arm  with 


THE   OBLIQUE   TRIANGLE   OF   THE   ARM   AND   CHEST  IOQ 

less  discomfort  than  when  the  simple  triangle,  shown  in 
figure  134,  is  used;  on  this  account  it  is  to  be  preferred. 


FIG.  135. — COMPOUND    BRACHIO-CERVICAL    TRIANGLE. 


FIG.  136. — OBLIQUE  TRIANGLE  OF  THE  ARM  AND  CHEST — FIRST  METHOD. 

The   Oblique  Triangle   of  the  Arm  and   Chest. — First 
Method  (Fig.  136). — The  base  of  the  triangle  is  placed  be- 


no 


BANDAGING 


neath  the  wrist,  the  apex  projecting  beyond  the  elbow. 
The  extremities  are  then  carried  one  in  front  and  the  other 
behind  the  chest  and  fastened  over  the  opposite  shoulder. 
Bring  the  apex  around  the  arm  and  pin  it  in  front,  as  seen  in 
figure  136. 

Second  Method  (Fig.  137). — Place  the  base  of  the  triangle 
beneath  the  wrist,  allowing  the  apex  to  project  beyond  the 
elbow.  Carry  the  extremity  which  is  next  the  chest  over 
the  opposite  shoulder.  Pass  the  extremity  which  is  on  the 


FIG.  137. — OBLIQUE  TRIANGLE  OF  THE  ARM  AND   CHEST — SECOND   METHOD. 

outer  side  of  the  forearm  through  the  axilla  of  the  injured 
side,  and  fasten  it  to  that  which  was  carried  over  the  sound 
shoulder.  The  apex  is  then  to  be  folded  around  backward 
and  tucked  in  beneath  the  arm.  (See  Fig.  137.) 

Triangles  for  the  Suspension  of  the  Arm  from  the  Injured 
Side. — First  Method  (Fig.  138). — Place  the  base  of  a  triangle 
on  the  front  of  the  chest,  apex  downward,  and  carry  the  ex- 
tremities around  the  body  and  fasten  them  posteriorly  on 
the  sound  side.  Bring  the  apex  up  in  front  of  the  arm  and 
connect  it,  by  means  of  a  strip  of  bandage,  over  the  shoulder 


TRIANGLE   FOR   SUSPENDING   ARM   FROM   SIDE 


III 


of  the  injured  side,  to  the  handkerchief  on  the  back,  as  seen 
in  figure  138. 


FIG.  138. — TRIANGLE  FOR  SUSPENSION  OF  THE  ARM  FROM  THE  INJURED  SIDE- 
FIRST  METHOD. 


FIG.  139. 

Second  Method  (Fig.  139). — Place  the  base  of  a  triangle 
obliquely  beneath  the  wrist,  the  apex  projecting  beyond  the 
elbow.  Carry  the  posterior  extremity  beneath  the  axilla 


112 


BANDAGING 


of  the  sound  side  and  the  anterior  one  over  the  shoulder 
of  the  injured  side.  Tie  them  together  on  the  back.  The 
apex  is  then  brought  around  the  arm  and  pinned  in  front. 
(See  Fig.  139.) 

Third  Method  (Fig.  140). — Place  the  base  of  the  triangle 
beneath  the  wrist.  The  posterior  extremity  having  been 
carried  directly  upward  in  front  of  the  shoulder,  the  anterior 
is  passed  through  the  axilla  and  around  the  back  of  the 


FIG.  140. — TRIANGLE  FOR  SUSPENDING  THE  ARM  FROM  THE  INJURED 
SIDE — THIRD  METHOD. 


shoulder,  to  be  fastened  to  the  posterior  extremity  on  top. 
The  apex  is  tucked  in  under  the  arm  (Fig.  140). 

Fourth  Method  (Fig.  141). — In  order  to  prevent  the  band- 
age from  becoming  displaced  by  slipping  off  the  point  of 
the  shoulder,  the  following  is  suggested :  A  cravat  is  fastened 
over  the  shoulder  of  the  injured  side  and  around  the  oppo- 
site axilla.  The  base  of  the  triangle  is  placed  beneath  the 
wrist,  the  apex  projecting  beyond  the  elbow.  The  an- 
terior extremity  having  been  carried  up  to  the  front  of  the 
shoulder,  the  posterior  one  is  carried  up  behind  the  shoulder, 


MAYOR'S  BANDAGE  FOR  FRACTURED  CLAVICLE  113 


FIG    141. — TRIANGLE  FOR  SUSPENDING  THE  ARM  FROM  THE  INJURED 
SIDE — FOURTH  METHOD. 


FIG.  142. — MAYOR'S  BANDAGE  FOR  FRACTURED  CLAVICLE. 


1 14  BANDAGING 

passed  beneath  the  cravat  on  top  and  fastened  to  the  ante- 
rior extremity  in  front,  as  seen  in  figure  141.  The  apex  is 
folded  around  the  arm  and  pinned  in  front. 

Mayor's  Bandage  for  Fractured  Clavicle  (Fig.  142). — The 
arm  having  been  flexed  at  a  right  angle,  it  is  confined  to  the 
side  by  a  triangular  handkerchief,  the  base  being  placed  just 
above  the  forearm  and  the  two  extremities  being  fastened  on 
the  back.  The  apex  is  allowed  to  hang  down  in  front.  The 
two  folds  forming  the  apex  are  then  carried  up  between  the 
arm  and  the  body,  and  the  under  one  passed  to  the  sound 


FIG.  143. — GOSSELIN'S  BANDAGE  FOR  FRACTURED  CLAVICLE. 

shoulder,  while  the  upper  one  is  carried  to  the  affected  shoul- 
der. A  broad  piece  of  bandage  is  fastened  to  one  apex  and 
carried  down  beneath  the  handkerchief  at  the  back  to  be 
brought  up  again  and  fastened  to  the  other  apex  on  the  op- 
posite shoulder,  as  seen  in  figure  142. 

Gosselin's  Modification  of  Mayor's  Bandage  (Fig.  143). 
— The  base  of  the  triangle  being  placed  on  the  chest,  the  two 
extremities  are  tied  behind  the  back,  the  two  folds  forming 


THE   TRIANGLE   CAP   OF   THE   SHOULDER  11$ 

the  apex  being  allowed  to  hang  down  in  front.  The  first 
fold  is  to  be  carried  up  beneath  the  arm  to  the  affected 
shoulder.  The  second  fold  is  brought  up  over  the  arm  to- 
ward the  sound  shoulder.  A  broad  strip  of  bandage  is  then 
fastened  to  it  and  carried  over  the  sound  shoulder,  down  be- 
neath the  handkerchief  at  the  back  and  up  over  the  affected 
shoulder,  to  be  fastened  to  the  apex  of  the  first  fold,  as  seen 
in  figure  143. 

This  is  a  convenient  and  effective  dressing  to  use,  especially  in 
children,  after  the  more  solid  dressings  have  been  discarded.  I  prefer 
it  to  Mayor's  original  bandage,  as  given  above. 


FIG.  144. — TRIANGULAR    CAP    OF    THE    SHOULDER. 


5.  HANDKERCHIEFS  FOR  THE  UPPER  EXTREMITY 

The  Triangular  Cap  of  the  Shoulder  (Fig.  144). — A  cravat 
is  tied  loosely  around  the  neck.  The  base  of  a  triangle  be- 
ing placed  on  the  outer  side  of  the  arm  near  the  shoulder,  its 
two  extremities  should  be  carried  around  it  and  tied.  The 


n6 


BANDAGING 


apex  is  then  brought  up  over  the  shoulder,  passed  under  the 
cravat  around  the  neck  and  fastened  with  a  pin.  (See  Fig. 
144.) 

This  is  a  very  useful  bandage  to  retain  applications  on  the  shoulder. 
By  unpinning  the  apex  of  the  triangle  the  handkerchief  can  be  turned 
down  and  the  parts  beneath  inspected. 

The  Triangular  Cap  of  the  Shoulder. — Agnew's  Method 
(Fig.  145).  Professor  Agnew  ("Surgery,"  vol.  i,  p.  713) 


FIG.  145. — TRIANGULAR  CAP  OF  THE  SHOULDER — AGNEW'S  METHOD. 


prefers  applying  the  triangular  cap  of  the  shoulder  by 
placing  the  base  over  the  top  of  the  shoulder  and  carrying 
the  extremities  down  under  the  axilla  and  tying  them 
around  the  arm.  The  apex  is  then  turned  up  and  pinned. 
(See  Fig.  145.) 

The  Palmar  Triangle  (Fig.  146).— The  base  of  the  tri- 
angle is  placed  at  the  wrist,  and  the  apex  folded  up  over  the 
ends  of  the  fingers.  The  two  extremities  are  then  carried 
around  the  hand,  one  on  each  side,  and  tied  around  the 
wrist  as  seen  in  figure  146. 


THE  CRAVAT  FOR  THE  HAND  II 7 

If  the  apex  projects  at  the  wrist  above  the  base  of  the  tri- 
angle, it  may  be  either  turned  down  and  pinned  or  else  con- 
fined by  the  knot.  This  is  a  convenient  bandage  to  retain 
applications  to  the  hand,  particularly  in  burn  cases,  or  to 


FIG.  146. — THE  PALMAR  TRIANGLE. 


FIG.  147. — CRAVAT  FOR  THE  HAND. 

cover  a  previously  applied  dressing  to  prevent  its  getting 
soiled. 

The  Cravat  for  the  Hand  (Fig  147).— The  body  of  the  cra- 
vat is  placed  between  the  thumb  and  forefinger  and  its 
extremities  carried  up  and  fastened  around  the  wrist.  (See 
Fig.  147.) 

The  cravat  can  be  applied  in  many  other  ways  both  to  the 


Il8  BANDAGING 

hand  and  various  parts  of  the  upper  extremity  according  to 
the  indications  which  it  is  desired  to  fulfil. 


6.  HANDKERCHIEFS    FOR   THE    PUBIC    REGION 

The  Sacro-pubic  Triangle. — Mayor  (Fig.  148).  Place 
the  base  of  a  large  triangle  over  the  sacrum  and  fasten  its 
extremities  around  the  body  in  front.  Carry  the  apex  down 


FIG.  148. — SACRO-PUBIC    TRIANGLE. 

beneath  the  perineum  and  then  up  in  front  of  the  pubis  and 
fasten  it  by  a  safety  pin  (Fig.  148). 

A  useful  bandage  to  retain  dressings  to  the  sacrum  or  both  buttocks. 

The  Scrotal  Triangle. — (Suspensory  Bandage  of  the  Scro- 
tum, Fig.  149.)  A  long  cravat  is  first  tied  around  the  body 
just  above  the  hips.  The  base  of  a  triangle  is  then  placed 
beneath  and  behind  the  scrotum  and  its  two  extremities 
brought  up  and  passed  around  the  cravat  from  above  down- 
ward. They  are  then  brought  around  the  outer  edges  of  the 
handkerchief  and  tied  in  front,  as  seen  in  figure  149.  Bring 
the  apex  up,  carry  it  around  the  cravat  from  below  upward, 


THE   SCROTAL   SQUARE  119 

and  pass  it  beneath  the  knot  formed  by  tying  the  extremi- 
ties of  the  triangle. 

This  is  a  convenient  dressing  when  the  ordinary  knit  suspensory 
bandage  of  the  shops  is  either  unsuitable  or  cannot  be  obtained. 


FIG.  149. — SCROTAL  TRIANGLE. 


FIG.  150. — SCROTAL  SQUARE. 

The  Scrotal  Square. — Devised  by  Dr.  H.  Beates  (Fig.  150). 
Place  one  side  of  a  square  handkerchief  beneath  the  scrotum 
and  tie  its  two  corners  over  the  root  of  the  penis.  The  re- 
maining corners  are  then  taken  one  in  each  hand  and  twisted 


1 2O  BANDAGING 

two  or  three  times.  Then  bring  them  up  and  pass  them 
beneath  the  handkerchief  at  the  root  of  the  penis  from  above 
downward,  bringing  them  out  at  the  sides  and  tying  or 
pinning  them  in  front,  precisely  as  is  shown  in  figure  149  of 
the  scrotal  triangle. 

It  is  not  a  suspensory  bandage  and  should  not  be  employed  when 
support  is  required.  It  is  useful  in  cases  of  troubles  affecting  the  penis, 
as  any  discharge  which  exists  can  be  provided  for  and  prevented  from 
soiling  the  patient's  clothes.  It  may  be  used  in  patients  confined  to 
bed. 

7.  HANDKERCHIEFS  FOR  THE  LOWER  EXTREMITY  AND  TRUNK 

The  Ilio -inguinal  Cravat. — (The  Cruro-pehic  Cravat  of 
Mayor,  Fig.  151.)  Place  the  body  of  a  large  cravat  over  the 
inguinal  region.  Carry  the  upper  extremity  around  the 


FIG.  151. — ILIO-INGUINAL  CRAVAT. 

body  and  the  lower  extremity  around  the  thigh,  knotting 
the  two  ends  in  front,  as  seen  in  figure  151. 

The  Double  Ilio-inguinal  Cravat. — (The  Sacro-bi-crural 
Cravat  of  Mayor,  Fig.  152.)     Place  the  body  of  the  long 


THE   DOUBLE   ILIO-INGUINAL  CRAVAT 


121 


cravat  over  the  upper  part  of  the  sacrum,  bringing  its  two 
extremities  around  the  body,  then  down  in  front  of  each 


FIG.  152. — DOUBLE  ILIO-INGUINAL  CRAVAT. 


FIG.  153. — ILIO-FEMORAL  TRIANGLE. 


groin  and  around  the  thighs,  to  be  fastened  on  the  opposite 
side  of  the  body,  as  seen  in  figure  152. 

These  two  bandages  necessitate  the  use  of  such  extremely  long  cravats 
that  they  are  seldom  employed. 


122 


BANDAGING 


The  Ilio -femoral  Triangle. — (The  Sub-femoral  Triangle  of 
Mayor,  or  Triangular  Cap  of  the  Buttocks,  Fig.  153.)  A  long 
cravat  is  fastened  around  the  waist.  The  base  of  a  triangle 
is  then  placed  in  the  gluteo-femoral  fold,  and  its  extremities 
fastened  around  the  thigh.  Carry  the  apex  up  and  pass  it 


FlG.    154. TlBIO-CERVICAL     SLING. 


beneath  the  cravat  around  the  waist,  turning  it  down  and 
pinning  it  to  the  body  of  the  triangle.     (See  Fig.  153.) 

A  most  useful  bandage  for  retaining  applications  to  the  region  of 
the  buttock,  hip,  or  even  groin.     By  unpinning  the  apex  and  turning  it 


THE   TARSO-PELVIC  CRAVAT 


123 


down,  ready  access  can  be  had  to  the  dressing  beneath,  without  disturb- 
ing the  patient. 

The  Tibio-cervical  Sling  (Fig.  154). — Place  the  body  of  a 
long  cravat  on  the  shoulder  of  the  sound  side,  and  fasten  its 
extremities  together  low  down  on  the  opposite  side,  thus 
forming  a  sort  of  sash.  After  flexing  the  leg  on  the  thigh, 
place  the  base  of  a  triangle  near  the  foot,  allowing  its  apex  to 


FIG.  155. — TARSO-PELVIC    CRAVAT. 


project  beyond  the  point  of  the  knee.  Carry  the  two  ex- 
tremities upward,  one  on  each  side  of  the  thigh,  and  tie  them 
to  the  cravat  above,  as  seen  in  figure  154.  The  apex  is  then 
folded  around  the  knee  and  pinned  to  its  outer  side. 

It  is  used  to  support  the  leg  after  fracture,  the  patient  be- 
ing allowed  to  walk  about  on  crutches  without  using  the 
injured  member. 

The  Tarso -pelvic  Cravat. — Mayor  (Fig.  155).    Tie  a  long 


124  BANDAGING 

cravat  around  the  waist  and  a  short  one  around  the  in- 
step, connect  these  two  with  a  third  cravat,  as  seen  in  figure 
155,  the  knee  being  flexed  nearly  or  quite  at  a  right  angle. 

Used  the  same  as  the  tibio-cervical  sling. 

8.  THE  HANDKERCHIEFS  FOR  THE  LOWER  EXTREMITY 

The  Tarso -femoral  Cravat  (Fig.  156). — Tie  a  cravat 
around  the  thigh  a  short  distance  above  the  patella.  Place 
the  body  of  a  long  cravat  on  the  dorsum  of  the  foot,  and 
carry  its  extremities  under  the  sole  and  up  along  the  sides 
of  the  heel,  to  be  fastened  to  the  cravat  around  the  thigh 
(Fig.  156). 

It  may  be  used  in  injuries  of  the  back  of  the  leg,  either  to  keep  the 
leg  flexed  on  the  thigh  or  the  foot  extended  on  the  leg. 

The  Tarso-patellar  Cravat  (Fig.  157). — Place  the  body  of 
a  cravat  on  the  front  of  the  thigh,  just  above  the  patella. 
Carry  its  extremities  around,  crossing  in  the  popliteal  space, 
fastening  them  just  below  the  patella.  Place  the  body  of  a 
second  cravat  on  the  sole  of  the  foot,  and  make  a  single  knot 
on  the  instep;  then  carry  the  extremities  upward  on  each 
side  of  the  leg,  and  fasten  them  to  the  cravat  around  the 
lower  part  of  the  thigh,  as  seen  in  figure  157. 

It  is  intended  as  a  temporary  dressing  in  fracture  of  the  patella. 

The  Triangular  Cap  of  the  Knee  (Fig.  158). — Place  the 
base  of  the  triangle  below  the  patella,  carrying  its  extre- 
mities around  the  popliteal  space,  and  fasten  them  above 
the  patella.  Bring  the  apex  up  over  the  front  of  the  joint, 
pass  it  beneath  the  part  around  the  thigh,  and  turn  it 
down,  fastening  it  with  a  pin  (Fig.  158). 

This  may  be  used  instead  of  the  roller  bandage  to  retain  applications 
to  the  knee. 


THE   MALLEOLO-PHALANGEAL   TRIANGLE 


125 


The  Tibial  Triangle  (Fig.  158).— Place  the  base  of  the  tri- 
angle obliquely  across  the  leg,  the  apex  being  downward. 
Carry  the  upper  extremity  around  and  pin  it  to  the  body  of 
the  triangle  near  its  base.  Bring  the  lower  extremity  around 


Triangular 
cap  of  the 
knee. 


Tibial 
triangle. 


FIG.    156.— TARSO- 
FEMORAL  CRAVAT. 


FIG.  157. — TARSO-PATELLAR 
CRAVAT. 


FIG.  158. 


and  fasten  it  lower  down  near  the  apex  of  the  triangle. 
Then  turn  the  apex  up  and  pin  it  as  seen  in  figure  158. 

The  Tibial  Cravat  (Fig.  158).— Place  the  body  of  the 
cravat  on  the  leg,  transverse  to  its  long  axis.  Carry  the 
extremities  around  the  limb,  tying  them  in  front,  as  seen  in 
figure  158. 

The  Tarso-malleolar  Cravat  (Fig.  158).— Place  the  body 
of  the  cravat  on  the  sole  of  the  foot  and  carry  its  extremities 
over  the  instep  and  fasten  them  around  the  ankles,  as  seen 
in  figure  158. 

The  Malleolo-phalangeal  Triangle  (Fig.  159). — Place  the 
base  of  a  triangle  on  the  back  of  the  leg  above  the  heel  and 


126 


BANDAGING 


bring  its  apex  up  over  the  toes  to  the  front  of  the  ankle- 
joint.  Carry  the  two  extremities  down  over  the  instep, 
around  under  the  sole  of  the  foot,  and  back  again  to  the 
instep,  where  they  are  to  be  tied,  as  seen  in  figure  159. 
The  apex  is  then  to  be  turned  down  and  fastened  by  the 


FIG.  159. — MALLEOLO-PHALANGEAL 
TRIANGLE. 


FIG.  1 60.- 


-TRIANGULAR  CAP  OF  THE 
HEEL. 


extremities  or  pinned.  •  Instead  of  fastening  the  extremities 
around  the  foot  as  just  described,  they  may,  if  so  preferred, 
be  tied  around  the  ankle. 

This  is  a  good  bandage  to  retain  applications  to  the  foot,  or  to  use  as 
a  cover  to  a  dressing  underneath  to  prevent  its  getting  soiled. 

The  Triangular  Cap  of  the  Heel  (Fig.  1 60)  .—Place  the 
base  of  the  triangle  on  the  sole  of  the  foot,  beneath  the 
instep,  and  carry  its  apex  up  the  back  of  the  leg.  Bring 
the  two  extremities  up  over  the  instep  and  fasten  them 
around  the  ankle,  as  seen  in  figure  160.  The  apex  should 
be  turned  down,  and  either  pinned  or  held  in  place  by  the 
extremities,  as  shown  in  the  illustration. 

The  Triangular  Cap  for  Stumps  (Fig.  1 6 1).— Place  the 
base  of  the  triangle  near  the  end  of  the  stump,  and  bring  its 
apex  up  on  the  opposite  side.  Carry  the  two  extremities 
around  the  part,  over  the  apex,  and  fasten  them  either  by 


BARTON'S  EXTENSION  CRAVAT 


127 


pinning  or  tying.     The  apex  should  be  turned  down  and 
pinned  or  included  in  the  knot,  as  shown  in  figure  161. 

Barton's  Extension  Cravat  (Figs.  162  and  163). — Fold  a 
handkerchief  into  the  form  of  a  cravat,  and  double  it  so  as  to 
make  one  end  twice  as  long  as  the  other.  Place  the  body  of 


FIG.  161. — TRIANGULAR  CAP  FOR  STUMPS. 


FIG.  162.  FIG.  163. 

FIGS.  162    AND    163. — BARTON'S    EXTENSION    CRAVAT. 


the  cravat  directly  over  the  point  of  the  heel,  beneath  the 
insertion  of  the  tendo  Achillis,  bringing  the  long  end  forward 
under  the  outer  ankle  and  the  short  end  forward  under  the 
inner  ankle.  Carry  the  long  end  over  the  instep  and  pass  it 
around  the  short  end  from  above  downward,  as  seen  in 


128  BANDAGING 

figure  162,  then  continue  it  beneath  the  sole  of  the  foot  and 
up  under  the  bandage  on  the  opposite  side,  as  shown  in 
figure  163.  It  will  now  be  seen  that  each  end  comes  up  the 
leg  from  beneath  the  transverse  portion  of  the  bandage,  and 
not  from  its  outer  side.  The  two  ends  are  then  turned 
down  and  knotted  beneath  the  foot,  the  knot  formed  by 


FIG.  164. — GERDY'S    EXTENSION    CRAVAT. 

the  bandage  on  the  inner  border  of  the  foot  being  adjusted 
so  as  to  lie  in  the  hollow  of  the  sole. 

Gerdy's  Extension  Cravat  (Fig.  164). — Place  the  body  of 
the  cravat  on  the  tendo  Achillis,  and  bring  the  two  extremi- 
ties forward,  crossing  them  over  the  instep.  Continue  them 
down  under  the  sole  of  the  foot  and  up  on  each  side,  passing 
them  beneath  the  turn  around  the  ankles.  They  are  then 
to  be  brought  down  and  tied  beneath  the  foot.  (See  Fig. 
164.) 


THIS  BOOK  IS  DUE  ON  THE  LAST  BATE 

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MAY  22  1933 


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1BHAKV 


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